Show Summary Details
Page of

Case 34 

Case 34
Case 34

Sarah Pendlebury

, Ursula Schulz

, Aneil Malhotra

, and Peter M. Rothwell

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2016. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 13 November 2018

A 43-year-old woman presented 10 days after a sudden-onset headache, which had persisted. Apart from the headache, she had no other symptoms and she looked clinically well. She was investigated for SAH. CT brain showed an area of hyperintense material in the cortical sulci at the vertex that was thought to be haemorrhage (Fig. 34.1). She proceeded to CTA which showed no aneurysm or arteriovenous malformation but did show irregularities of the distal posterior ICA bilaterally (Fig. 34.2). This unusual appearance led to a lumbar puncture (LP) being performed which was normal (no polymorphs, two lymphocytes, 640 red cells, no xanthochromia). MRI brain showed no brain lesion except for the area of hyperdense material in the cortical sulci at the vertex previously seen on CT (Fig. 34.3). Formal cerebral angiography (Fig. 34.4) showed short focal areas of stenosis in medium-sized arteries. A presumptive diagnosis of vasculitis was made and the patient was treated with steroids. Her headache improved, with further follow-up arranged in her local hospital.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.