Isolated noncompaction of the ventricular myocardium in a patient presenting with subarachnoid hemorrhage.

Our prehospital emergency team was called to a 40-yearold woman with a known history of multiple sclerosis without exacerbations in the last 20 years. She suffered several days from mainly frontal headache. On initial evaluation her blood pressure was 78/58 Hg with an arrhythmic heart rate of 83 bpm and polymorphic ventricular beats revealed in the rhythm-ECG. Respirations were shallow and peripheral oxygen saturation was not detectable due to cyanosis. Upon verbal stimulation she could shortly open her eyes but not respond vocally. She was vaguely moving her head and the upper extremities if asked to. A brief neurological examination revealed slight meningeal irritation, normal pupillary sizes with reaction to light. Blood glucose was 63 mg/dl. After she was given 10 l/min oxygen by a partial rebreathing mask, peripheral oxygen saturation raised to 98%. Fluid resuscitation with 500 ml crystalloid and 500 ml colloid solutions and a single dose of 10 μg Epinephrine IV resulted in normotensive blood pressure. The initial arrhythmia changed to a regular small-complex rhythm with suspected ST-segment elevations after administration of 150 mg Amiodarone IV. After stabilisation the patient was transported to a tertiary care university hospital. A primary evaluation by the attending anaesthesia and medical staff showed normal heart sounds without murmurs and no distended neck veins but moist rales on auscultation over all lung fields and a accompanying decreased peripheral oxygen