Repeated Medical PG Question- 74

#MEDICINE (NEET Pattern)

A 60 years old hypertensive female presents with history of sudden onset  severe headache and neck stiffness.  Image is head CT is given below.Diagnosis is?

A. Meningitis 

B. Intraparenchymal hemorrhage

C. Subarachnoid hemorrhage

D. Hemorrhagic stroke

Answer is C. Subarachnoid hemorrhage

INTRACRANIAL HEMORRHAGE 

• MC Site of hypertensive ICH – putamen (basal ganglia) 

• MC cause of SAH – head trauma 

• MCC of spontaneous SAH – Berry aneurysm  SACCULAR (BERRY) ANEURYSM 

• 85% of the aneurysms occur in the anterior circulation, mostly on the circle of Willis 

• Most common sites:

 ➢ Anterior cerebral artery/Anterior communicating artery complex: 30-40%

 ➢ Supraclinoid internal carotid artery ICA and ICA/Posterior communicating artery junction: 30% 

➢ Middle cerebral artery bi/trifurcation: 20-30% 

Clinical Manifestations: 

• Severe headache (the worst headache of life)  

• The headache is usually generalized, often with neck stiffness, and vomiting is common 

• Cause of death and disability: cerebral vasospasm. 

• M/c electrolyte abnormality: Hyponatremia (d/t inappropriate levels of ADH). 

• Expanding aneurysm at the junction of posterior communicating artery and internal carotid artery: 

▪️Third cranial nerve palsy 

▪️ Pupillary dilation

▪️ Loss of ipsilateral (but retained contralateral) light reflex 

▪️ Focal pain above or behind the eye. 

 

• Aneurysm in the cavernous sinus: sixth nerve palsy. 

• Expanding supraclinoid carotid or anterior cerebral artery aneurysm: visual field defects. •   

• IOC - noncontrast CT scan obtained within 72 hours  

Primary Intraventricular hemorrhage (IVH) 

• Primary: the dominant finding is that of blood in the ventricles, with little if any parenchymal blood 

• Causes: intraventricular tumors (ependymoma, choroid plexus metastases)

• PICA aneurysms tend to fill the 4th ventricle.