A 20-year-old man with new onset of seizures

[Oak]

A 20-year-old man with new onset of seizures and no history of hypertension is evaluated with a contrast-enhanced CT scan of the head, which demonstrates a mixed parenchymal and subarachnoid hemorrhage. The parenchymal hemorrhage is centered over one cerebral hemisphere. Which of the following is the most likely source of the hemorrhage?

A. Arteriovenous malformation
B. Berry aneurysm
C. Bridging vein
D. Charcot-Bouchard aneurysm
E. Middle meningeal artery

[bharat]

well for this question i will go for B. Berry aneurysm
becuse Charcot-Bouchard aneurysm is found after longstanding hypertension
so i hope b is correct.

[kenneth masamaro]

Originally Posted by Oak

A 20-year-old man with new onset of seizures and no history of hypertension is evaluated with a contrast-enhanced CT scan of the head, which demonstrates a mixed parenchymal and subarachnoid hemorrhage. The parenchymal hemorrhage is centered over one cerebral hemisphere. Which of the following is the most likely source of the hemorrhage?

A. Arteriovenous malformation
B. Berry aneurysm
C. Bridging vein
D. Charcot-Bouchard aneurysm
E. Middle meningeal artery

I'd go for B. Arteriovenous malformation is a risk factor for intraparenchymal haemorrhage but is not as common as it would be for a berry aneurysm being a source of a subarachnoid haemorrhage.Charcot-bouchard microaneurysms are associated with chronic hypertension.Middle meningeal artery is an unlikely source.

[Oak]

The correct answer is A. Arteriovenous malformations are composed of complex tangles of congenitally malformed vessels that typically involve the superficial or deep cerebral hemispheres. There is a slight male predominance, and bleeding typically occurs in adolescence or young adulthood. Symptoms may be those of subarachnoid hemorrhage (headache, increased intracranial pressure) and/or seizures. Surgical resection is usually required for therapy.

Berry aneurysms (choice B) can produce both subarachnoid and parenchymal hemorrhage, but are usually centered near the base of the brain.

Bleeding from bridging veins (choice C) causes subdural hematoma.

Charcot-Bouchard aneurysms (choice D) are small, intraparenchymal aneurysms that are related to hypertension.

Rupture of the middle meningeal artery (choice E) causes epidural hematoma.