A patient presented with thunder clap headache. Followed by unconsciousness with progressive III cranial nerve palsy. Etiology:
|B||Aneurysmal subarachnoid hemorrhage|
Aneurysmal subarachnoid hemorrhage
1). Sudden Severe onset headache, never experienced before, in the absence of focal neurological deficit, is the hallmark of SAH.
2). Transient loss of consciousness.
3). Neck rigidity may be present mimicking meningitis. Neck stiffness & vomiting: are common associations
4). Focal neurological deficit: uncommon.
5). Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm)
a. Third cranial nerve palsy: aneurysm at junction of PC A & ICA
b. Sixth nerve palsy: aneurysm in cavernous sinus
c. Occipital and posterior cervical pain: inferior cerebellar artery aneurysm (Ant. or Post.)
d. Pain behind the eye: MCA aneurysm
6). Aneurysms may undergo small ruptures or leaks, so called sentinel bleeds.
a. Most common site of berry aneurysm is junction of ACA with anterior communicating artery.
b. Vertebral A is the least common site of berry aneurysm.
c. Most common nerve involved in berry aneurysm is IIIrd nerve.