A 55-year-old man is admitted to the hospital with a complaint of severe headaches. A lumbar puncture reveals traces of blood in the cerebrospinal fluid. Which of the following conditions has most likely occurred in this patient?
When a berry aneurysm ruptures, the blood flows into the subarachnoid space and therefore mixes with CSF; thus, blood would be present in the CSF when a lumbar puncture is performed. The pterion overlies the anterior branch of the middle meningeal vessels, and damage to these vessels would result in an epidural hematoma, with compression of the brain. Leakage of branches of the middle meningeal artery within the temporal bone would cause blood vessels within the bone to leak, without direct connection to the CSF fluid. A tear of the cerebral vein in the superior sagittal sinus would lead to a subdural hematoma, in which the blood collects in the subdural space, without entry to CSF. The occlusion of the internal carotid artery by way of clot would not lead to leakage of blood into the CSF.
Fracture of the pterion with vascular injury
A ruptured "berry" aneurysm
Leakage of branches of the middle meningeal vein within the temporal bone
A tear of the cerebral vein at the entrance to the superior sagittal sinus
Head & Neck