Course 3, Case 8
Kas 3-8E: Patient with a severe sudden headache
A female patient of 58 years suffered a sudden headache with following nausea, vomiting and
photophobia. Admitted 1,5 hours after the onset of symptoms.
Family history: Of no importance
Personal history: From time to time some headache but never of this acute intensity. She has
experienced the usual child diseases and minimal traumas. Other personal history negative.
Actual presentation: A sudden onset severe headache, followed by nausea and vomiting; it
started before lunch, in the office. Immediately the patient was unable to hold balance,
sweated, was pale. During transport to the hospital she had tachycardia of 102/min.
Clinical examination: Blood pressure 150/90, P: 90/min.
Well oriented, but exhausted. Photophobia. Isocoria, reaction to light correct. Severe
headache, stronger than in her previous attacks. Pain diffuse, symmetrical, although at the
starting point more on the right. Meningeal signs slightly positive. Chvostek positive
bilaterally, axial reflexes positive. Mingazzini 10 cm drop down on the upper as well as lower
extremity left, reflexes generally lower; tactile sensitivity increased on the left, dysaesthesias
on the left.
CT: Blood in subarachnoid spaces, an unclear finding on the anterior cerebral artery.
Angiography of cerebral vessels conceived.
Questions and tasks:
1.
2.
3.
4.
5.
What is the most probable cause of the present symptoms?
What is a arterio-venous malformation. What is an aneurysm?
Pathophysiology of late complications of subarachnoid haemorrhage.
Pathology: intracranial extracerebral bleeding
Central nervous system haemorrhage and its consequences