questions 3

Aneurysms

Topic updated on 06/02/17 2:23pm

Snapshot
  • A 58-year-old woman presents to the emergency department with a severe headache of sudden onset. The headache occurred immediately while at rest, and she describes the headache as the most severe she has ever had. Her headache symptoms are also accompanied by photophobia. She has tried ibuprofen and sumatriptan, but it has not improved her symptoms. Medical history is significant for migraine headache, hypertension, cigarette smoking, and alcohol use disorder. Physical examination is notable for nuchal rigidity. A non-contrast head CT is shown. (Subarachnoid hemorrhage)
Saccular Aneurysm
 

 
  • Clinical definition
    • a balloon-like outpouching of the vessel wall which is also referred to as
      • berry aneurysms which are composed of
        • a neck that is connected to the originating vessel and
          • and dome that has the possibility to rupture
  • Saccular (berry) aneurysm
    • these aneurysms typically arise from
      • branch points (bifurcations) of the circle of Willis
    • are more prone to rupture than fusiform aneurysms
    • aneurysm locations
      • anterior communicating artery (most common)
        • clinical correlate
          • bitemporal hemianopsia secondary to
            • aneurysm compression of the optic chiasm
      • posterior communicating artery
        • clinical correlate
          • ipsilateral oculomotor nerve palsy secondary to
            • aneurysm compression
      • middle cerebral artery
    • risk factors
      • hypertension
      • increasing age
      • smoking
      • autosomal dominant polycystic kidney disease (ADPKD)
      • Ehlers-Danlos syndrome
      • Moyamoya syndrome
Charcot-Bouchard Aneurysm
 

 
  • Clinical definition
    • small vessel aneurysm (e.g., lenticulostriate arteries) that
      • result from chronic hypertension
      • can rupture, leading to an
        • intraparenchymal hypertensive hemorrhage which commonly affects the
          • basal ganglia
          • thalamus
          • cerebellum
          • pons


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(M1.NE.17) A 47-year-old male with a medical history significant for hypertension, recurrent urinary tract infections, mitral valve prolapse, and diverticulosis experiences a sudden, severe headache while watching television on his couch. He calls 911 and reports to paramedics that he feels as if "someone shot me in the back of my head." He is rushed to the emergency room. On exam, he shows no focal neurological deficits but has significant nuchal rigidity and photophobia. Of the options below, what is the most likely etiology of this man's headache? Topic Review Topic

1. Migraine
2. Brain Tumor
3. Temporal Arteritis
4. Subarachnoid Hemorrhage
5. Carotid Dissection

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