An 85-year-old man presents with a sudden onset of severe occipital headache and has vomited on two occasions since the headache began. He also complains of double vision. He has a history of hypeension. His examination findings are : - Glasgow Coma Scale 15/15 - Mild neck stiffness noted - Power 5/5 in both upper and lower limbs. Where is the likely site of pathology?
-Double vision and vomiting implies features of Raised ICP & HTN -Mild neck stiffness indicates probability of SAH -Presence of ptosis ,since in the question eye is pulled laterally and down it means there is unopposed 6th nerve as the 3rd nerve is damaged. If Berry aneurysm ruptures into ACA : no cranial nerve palsy SAH w.r.t 3rd nerve palsy : PCA involvement HTN can lead to Charcot Bouchard Aneurysm can rupture-3rd nerve palsy Diagnosis: HTN with 3rd nerve palsy SAH : vascular malformation ruptured m/c nerve involved in ruptured/unruptured berry aneurysm is 3rd nerve as it runs adjacent to PCA
Anterior communicating aery
Posterior communicating aery
Lenticulostriate aery
P1 Segment of Posterior cerebral aery
Headache And Migraine