Don't Let Old Habits Die – Lesson Learnt the Hard Way in a Rare Case of Ruptured Aneurysm with Colpocephaly

Abstract A ruptured aneurysm is an emergency. With recent advances, most neurosurgeons' approach is comprehensive nervous system examination, investigations, and proceeding to treatment. The old habit of systemic examination is getting lost. We encountered a ruptured aneurysm case and paid a price for forgetting systemic examination. A late-30-year-old-female presented with a ruptured aneurysm and poor chest condition. Her CT head showed subarachnoid hemorrhage with colpocephaly. Her colpocephaly was asymptomatic. We performed clipping. However, she developed weakness in both her lower limbs. A postoperative scan showed a small infarct and vasospasm. An accidental examination of the back showed spina bifida, and magnetic resonance imaging of the spine confirmed adult tethered cord syndrome. A nerve conduction velocity study confirmed neuropraxic injury. She was managed conservatively. An abnormal finding on a scan, not related to the primary disease, should not be ignored. Systemic examination of the patient can decrease the chances of disastrous complications due to an unrelated disease.