A 34-year-old woman with autosomal dominant polycystic kidney disease presents with sudden thunderclap headache and meningismus. CT shows subarachnoid hemorrhage in the basal cisterns without intraparenchymal blood. The vascular lesion most likely responsible is:

• A Mycotic aneurysm of the middle cerebral artery
• B Charcot-Bouchard microaneurysm of a lenticulostriate artery
• C Saccular (berry) aneurysm of the anterior communicating artery ✓
• D Dissecting aneurysm of the vertebral artery

Explanation

Berry aneurysms occur at branch points of the circle of Willis, most often the anterior communicating artery, and rupture into the subarachnoid space. Autosomal dominant polycystic kidney disease is a well-established association, along with familial clustering, hypertension, smoking, and Ehlers-Danlos type IV. Charcot-Bouchard microaneurysms rupture within brain parenchyma causing intracerebral hemorrhage in hypertensive patients, not subarachnoid hemorrhage, which excludes the strongest distractor.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.