A 48 year old woman has developed chronic renal failure, and a renal scan showed bilaterally enlarged kidneys with multiple cysts. She had a sudden onset severe headache. A cerebral angiogram demonstrated marked narrowing of cerebral aery branches near the base of the brain, consistent with vasospasm, but no intraparenchymal hemorrhage were present. Which of the following condition MOST likely produced these findings?
The blood irritates the aeries. This effect is often delayed by several days following the initial hemorrhagic event. Berry aneurysms are located in the circle of Willis at the base of the brain, and rupture leads to extravasation of blood into the subarachnoid space. Her renal scan suggests a diagnosis of dominant polycystic kidney disease (DPKD). About 10% of persons with ADPKD develop berry aneurysms.
Bacterial meningitis
Severe atherosclerosis
Malignant hypeension
Subarachnoid hemorrhage