Question

A 40-year-old female patient complains of a persistent headache. A CT scan of the head was performed, as shown below. What is the most accurate diagnosis? 

• A. Subarachnoid hemorrhage (SAH)
• B. Epidural hemorrhage
• C. Subdural hemorrhage
• D. Intraparenchymal hemorrhage

Hint:

In a patient with sudden severe headache, a subarachnoid hemorrhage (SAH) should be suspected, especially if blood is seen in the subarachnoid space on a CT scan.

Answer 1

The Correct Option is A

Answer: Subarachnoid hemorrhage (SAH).

This is best solved by matching the headache and the CT bleeding pattern to the right space inside the skull. Each type of brain bleed has its own shape on a plain CT scan.

The history points the way first. A sudden, very severe headache, often called the worst headache of life, is the classic warning of a subarachnoid bleed, usually from a burst aneurysm.

On a non-contrast CT, fresh blood looks white (hyperdense). In SAH this white blood spreads into the natural spaces and grooves over the surface of the brain, such as the basal cisterns and the fissures between the lobes, giving a star-like pattern. That is what this scan shows.

The other bleeds have different shapes:
- Epidural blood forms a tight lens (biconvex) shape and often follows a skull fracture.
- Subdural blood is a thin crescent that hugs the curve of the brain.
- Intraparenchymal blood sits as a clot inside the brain tissue itself.

Blood spread over the surface spaces, together with a sudden thunderclap headache, fits only one answer: subarachnoid hemorrhage (option 1).