A patient presents with sudden headache and vomiting and unconsciousness. The diagnosis is
• MC cause: Trauma >Spontaneous rupture of Berry aneurysm
Clinical Features
• Sudden transient loss of consciousness (occurs in nearly half of the patients)
• Excruciating severe headache: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associated
• Neck stiffness and vomiting: are common associations
• Focal neurological deficit: uncommon.
• Sudden headache in the absence of focal neurological deficit is the hallmark of aneurysmal rupture.
• Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm):
−− Third cranial nerve palsy: Aneurysm at junction of PCA and ICA
−− Sixth nerve palsy: Aneurysm in cavernous sinus
−− Occipital and posterior cervical pain: Inferior cerebellar artery aneurysm
−− Pain in or behind the eye: MCA aneurysm
Diagnosis
• 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 fluid)
Subarachnoid hemorrhage -
Intracerebral hemorrhage
Subdural hemorrhage
Extradural hemorrhage