An elderly, hypertensive patient presented with sudden onset headache, vomiting, neck rigidity without focal neurological deficit. Diagnosis:(AIIMS November 2013. May 2013)
Ans. a. Subarachnoid hemorrhage (Ref: Harrison 19/e p1784, 18/e p2262-2263; Sabiston 19/e p1880-1882; Schwartz 9/e p1534-1536; Bailey 25/e p304)An elderly, hypertensive patient presented with sudden onset headache, vomiting, neck rigidity without focal neurological deficit, diagnosis in this case is subarachnoid hemorrhage.Subarachnoid HemorrhageMC cause: Trauma >Spontaneous rupture of Berry aneurysmQClinical Features:Sudden transient loss of consciousnessQ (occurs in nearly half of the patients)Excruciating severe headacheQ: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associatedNeck stiffness and vomitingQ: are common associationsFocal neurological deficit: uncommon.Sudden headache in the absence of focal neurological deficit is the hallmark of aneurysmal rupture. QDiagnosis:Non contrast CT scan: Investigation of choice (Lumbar puncture is not indicated prior to an imaging procedure)CSF picture: Hallmark of aneurysmal rupture is blood in CSF (Xanthochromic spinal fluidQ)Lumbar puncture should be performed if the CT scan fails to establish the diagnosis of SAH and no mass lesion or obstructive hydrocephalus is found to establish the presence of subarachnoid bloodQTreatment:Traumatic subarachnoid hemorrhage is managed conservativelyQ.
Subarachnoid hemorrhage
Ischemic stroke
Subdural hemorrhage
Meningitis
C.N.S.