A 34-year-old woman presents with sudden severe headache, vomiting, and neck stiffness. CT shows subarachnoid hemorrhage. She has a history of hypertension and bilateral enlarged kidneys on ultrasound. Which is the most likely source of her bleeding?

• A Mycotic aneurysm of the middle cerebral artery
• B Ruptured Charcot-Bouchard microaneurysm in the basal ganglia
• C Dissecting aneurysm of the vertebral artery
• D Ruptured saccular (berry) aneurysm of the anterior communicating artery ✓

Explanation

Autosomal dominant polycystic kidney disease is strongly associated with intracranial berry aneurysms, and their rupture produces subarachnoid hemorrhage, most commonly at the anterior communicating artery in the circle of Willis. Berry aneurysms arise from congenital medial defects at arterial bifurcations and are aggravated by hypertension. Charcot-Bouchard microaneurysms occur in penetrating basal ganglionic vessels and cause intraparenchymal, not subarachnoid, hemorrhage. Mycotic aneurysms require infective endocarditis as a setting.

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.