Subarachnoid Haemorrhage with Polycystic Kidney Disease

You are assessing a patient on the neurosurgical ward who is booked on your list tomorrow for coiling of cerebral aneurysms in the hospital's interventional radiology suite. The 56-year-old woman presented earlier in the day with a two day history of severe headache, vomiting and malaise that was unresponsive to paracetamol. There has been no change to her level of consciousness or focal neurological deficits. Cranial CT revealed five intracerebral aneurysms, the largest in the anterior communicating artery. There is evidence of diffuse subarachnoid haemorrhage, Fisher grade 2. Her vital signs are: - blood pressure 145/75 mmHg (MAP 88 mmHg) - pulse 85/min sinus rhythm Past medical history: Polycystic kidney disease - renal transplant 10 years ago - end-stage renal disease treated with haemodialysis for two years prior to transplantation Hypertension Medications: - atorvastatin 20mg daily - enalapril 5mg BD - mycophenolate 1g BD - prednisone 5mg daily - tacrolimus 5mg BD - trimethoprim/sulphamethoxazole one tab BD