Image Based Question-68031

A 60 year old woman ,suffering from hypertension and with a history of smoking presented with a severe headache,which is according to her,the worst headache felt in her life.

CT scan findings are shown in the image.In the second image,the site of hemoorhage in the brain is shown.What can be the most common cause for this condition?

A. AV malformation.

B. Aneurysm.

C. Hypertension.

D. Cavernous angioma.

Show Answer

Correct Answer » B Explanation

Ans:B. Aneurysm.

The condition shown in the picture above represents Subarachnoid hemorrhage.

CT scan in the image shows:

• There is high-attenuation blood in the Sylvian fissures (blue arrows) and the interhemispheric fissure (red arrow) seen on this non-contrast enhanced CT of the brain. Do not confuse normal, physiologic calcifications (white and black arrows) for blood. There is high-attenuation blood in the Sylvian fissures (blue arrows) and the interhemispheric fissure (red arrow) seen on this non-contrast enhanced CT of the brain. Do not confuse normal, physiologic calcifications (white and black arrows) for blood.

Most common cause of subarachnoid hemorrhage is Aneurysm.

Subarachnoid hemorrhage

Clinical presentation

• Patients typically present with a thunderclap headache, usually the worst headache of their lives. It is often associated with photophobia and meningism. In a substantial number of patients (almost half 2), it is associated with collapse and loss of consciousness, even in those patients who subsequently regain consciousness and have a good grade.

• Focal neurological deficits often present either at the same time as a headache or soon thereafter .

• Patients can be graded into 5 groups based on their clinical presentation, using the commonly employed Hunt and Hess grading system, which is predictive of outcome.

Aetiology

• trauma (with associated cerebral contusion): traumatic subarachnoid haemorrhage

• spontaneous

• ruptured berry aneurysm: 85%

• perimesencephalic haemorrhage :10%

• arteriovenous malformation

• dural arteriovenous fistula

• spinal arteriovenous malformation

• venous infarction

• intradural arterial dissection

• pituitary apoplexy

• cocaine use

• cerebral vasculitis

Risk factors

• Vasculitis

• Fibromuscular dysplasia (FMD)

• Hypertension

• History of polycystic kidney disease

• Smoking

• heavy alcohol consumption