cctpat17

H: Adult woman, 34-years-old, throbbing headaches occured occasionally during the last years. Today she was sitting on the toilette and experienced a sudden, severe headache that was accompanied by nausea, vomiting and a feeling of weekness. The physical examination detected nuchal rigidity and the blood pressure is elevated. Known polycystic kidneys.

INFO/WWW-LINKS Fresh blood is high density compared with brain on CT and, at brain windows, appears white. As the clot absorbs, the lesion becomes isodens (2-3 weeks after bleeding) and, later, of low attenuation
Sites of intracranial heamorrhage/haematoma:
1) Between inner tabel and dura = extradural heamorrhage/haematoma
2) Between dura and arachnoid = subdural heamorrhage/haematoma
3) Between arachnoid and brain surface = subarachnoid heamorrhage/haematoma
4) Within brain = intracerebral heamorrhage/haematoma
5) Within ventricles = intraventricular heamorrhage/haematoma Rising intracranial pressure can be caused by e. g. head injury, meningoencephalitis, haemorrhage or cerebral oedema and tumour
Frequency of intracranial congenital (Berry) aneurysms at different sites: Anterior communicating artery > posterior communicating artery > middle cerebral artery

D: At brain windows evidence of fresh subarachnoid haemorrhage. Fresh blood is seen in the suprasellar cistern, ambient cisterns, the right sylvian fissure and anterior interhemispheric fissure. Blood is most obvious in the anterior interhemispheric fissure, making rupture of a middle cerebral artery aneurysm the probable cause.

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