Abstract
A 64-year-old patient presented with subarachnoid hemorrhage (SAH) due to ruptured right distal anterior cerebral artery aneurysm (DACAA), which was classified as large size. In addition to the rarity of this aneurysm, this patient had delayed neurogenic pulmonary edema (NPE), which is atypical in view of the onset of this systemic complication of SAH. In general, NPE develops immediately after the ictus. Since this patient also suffered from other serious systemic complications such as disseminated intravascular coagulation (DIC) and liver dysfunction, we chose interventional procedures followed by intensive treatments to improve his poor status. In spite of these treatments he became severely disabled. In this paper, we discuss not only the rarity of a case with large ruptured DACAA and delayed NPE but also the significance of appropriate management of the poor-grade patient with SAH.
