A 45-year-old woman with autosomal dominant polycystic kidney disease presents with sudden onset of the worst headache of her life followed by vomiting and neck stiffness. Non-contrast CT shows blood in the basal cisterns without intraparenchymal hemorrhage. What is the most likely source of bleeding?

• A Rupture of a saccular aneurysm at the anterior communicating artery ✓
• B Rupture of a Charcot-Bouchard microaneurysm
• C Arteriovenous malformation within the cerebral parenchyma
• D Dissection of the vertebral artery at the foramen magnum

Explanation

Sudden severe headache with blood confined to the subarachnoid space indicates rupture of a berry (saccular) aneurysm, most commonly arising at branch points of the circle of Willis, particularly the anterior communicating artery. Autosomal dominant polycystic kidney disease is a recognized predisposing condition. Charcot-Bouchard aneurysms occur in hypertensive deep perforators and cause intraparenchymal bleeds, while AVMs usually bleed into brain tissue.

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.