Question
What is the probable diagnosis for a patient who presented at the emergency department with a complaint of intense headache, showing no specific neurological impairment except for the presence of neck stiffness, and subsequently underwent an urgent CT scan that revealed the following result?
| A. |
Subdural hemorrhage
|
| B. |
Pituitary apoplexy
|
| C. |
Subarachnoid hemorrhage
|
| D. |
Pituitary carcinoma
|
Show Answer
|
Correct Answer » C
Explanation
|
|
The patient presents with:
- Sudden intense headache (“thunderclap headache”)
- Neck stiffness (meningismus)
- No focal neurological deficit initially
These are classic features of subarachnoid hemorrhage (SAH).
CT Scan Findings
- The CT image shows hyperdense blood within the basal cisterns/suprasellar cistern.
- Blood in the subarachnoid space appears hyperdense on non-contrast CT.
- This appearance is characteristic of subarachnoid hemorrhage.
Reasons to Rule Out Other Options
A. Subdural hemorrhage
- Typically crescent-shaped extra-axial collection
- Located along cerebral convexity
- Usually associated with trauma
- Does not produce basal cisternal hyperdensity
B. Pituitary apoplexy
- Presents with:
- Sudden headache
- Visual defects
- Ophthalmoplegia
- Altered consciousness
- CT/MRI shows hemorrhage or infarction in pituitary region
- Neck stiffness and diffuse basal cisternal blood are less typical
D. Pituitary carcinoma
- Extremely rare
- Chronic presentation
- Does not present as acute thunderclap headache with subarachnoid blood
