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Case 34 

Case 34
Chapter:
Case 34
Author(s):

Sarah Pendlebury

, Ursula Schulz

, Aneil Malhotra

, and Peter M. Rothwell

DOI:
10.1093/med/9780199539345.003.0208
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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.

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