A 43-year-old woman is brought to the emergency department because of a sudden and severe headache. Her blood pressure is 160/90 mm Hg and pulse is 90/min. Her pupils are symmetric and reactive to light and she can move all four extremities without weakness. CT of her head is shown below. This patient's condition is most likely caused by which of the following?

Question

A 43-year-old woman is brought to the emergency department because of a sudden and severe headache.  Her blood pressure is 160/90 mm Hg and pulse is 90/min.  Her pupils are symmetric and reactive to light and she can move all four extremities without weakness.  CT of her head is shown below.  This patient's condition is most likely caused by which of the following?

Quizplus · Accepted Answer

11ec160b_39dc_8f67_9249_ab3dc72f052d_MD0001_00 Clinically, the abrupt onset of a severe headache is very characteristic of subarachnoid hemorrhage (SAH), and the above non-contrast CT scan confirms this diagnosis (note the hyperdensity seen within the cisterns/sulci, arrows). The generalized, severe headache of SAH is often described by patients as "the worst headache of my life." Fever and nuchal rigidity may also be present. Focal neurological deficits are usually not present. Saccular (berry) aneurysms are the most common cause of SAH. These aneurysms usually occur at the circle of Willis, with the anterior communicating artery being the most common site. Berry aneurysms are associated with Ehlers-Danlos syndrome and autosomal dominant polycystic kidney disease. Arteriovenous malformations also predispose certain individuals to SAH. In SAH, blood accumulates between the arachnoid and pia mater. A CT scan without contrast is diagnostic. Lumbar puncture reveals gross blood or xanthochromia (yellow discoloration of cerebrospinal fluid). (Choice G) Cerebral amyloid angiopathy occurs in elderly patients. It may be asymptomatic or may lead to recurrent intracerebral hemorrhage. These bleeds usually affect small areas of the cerebral hemispheres and present with headache and focal neurologic deficits (i.e., paresis, sensory loss, etc). (Choice I) Charcot-Bouchard aneurysms are small in size (< 1 mm in diameter) and occur in patients with long-standing hypertension. They are found in the arterioles that supply the basal ganglia, internal capsule, and deep white matter. Charcot-Bouchard aneurysms can rupture and cause intracerebral hemorrhage, not SAH. Educational objective: Subarachnoid hemorrhage presents with a generalized, excruciating headache. It is classically described by patients as "the worst headache of my life." Subarachnoid hemorrhage usually occurs due to rupture of saccular (berry) aneurysms or arteriovenous malformations. Berry aneurysms of the circle of Willis are associated with autosomal dominant polycystic kidney disease.

A 43-Year-Old Woman Is Brought to the Emergency Department Because