A Rare Manifestation of Subarachnoid Hemorrhage: Case Report
Bleeding is a critical sign in many patients and continues or recurrent hemorrhage leads to emergency department (ED) visits. Epistaxis alone is a common problem, but when it presented with simultaneous otorrhagia become a very unpleasant event. Spontaneous epistaxis and otorrhagia necessitate imaging assessment to identification of underlying cause. A ruptured aneurysm or a possible underlying SAH should be evaluated by brain Computed Tomography. Advance diagnostic modalities for detection of underlying cause of SAH include: Computed Tomography Angiography, Magnetic Resonance Angiography and Digital Subtraction Angiography. A 57-years-old woman was referred to our tertiary hospital emergency department (ED) with otorrhagia and epistaxis. She had no history of headache, head trauma, hypertension and drug usage. In physical examination her vital signs were normal and Glasgow Coma Scale score on admission was 15. She had bilateral epistaxis and neurologic examination revealed no pathologic findings. ENT consultation was done, otoscopy reveal a normal tympanic membrane with bloody otorrhagia in the left external auditory canal. The epistaxis stop spontaneously and there was no finding on nose examination. She underwent further investigation for intracranial aneurysm or hemorrhage. Brain CT scan was performed and showed Sub Arachnoids Hemorrhage (SAH). She was candidate for brain CT angiography, which was normal. The patient, discharged from hospital after 1 week with stable vital sign and normal Brain CT scanning.