CVD q

[MudPhud20XX]

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So I am really bad at these images. can anyone walk me through this? Thank you.

A 33-year-old woman has experienced a severe headache accompanied by a perception of strange smells, beginning 2 days ago. On physical examination her temperature is 37.1° C (98.8° F) and blood pressure is 120/80 mmHg. A CT scan of her head with contrast shows a focal 2-cm bright subfrontal lesion. A brain MR angiogram reveals the finding shown in the image. Which of the following complications of this lesion is most likely to occur?

 

[SBR249]

severe headache is a strong sign of increased intracranial pressure so we can try to look for a lesion causing mass effects. The perception of strange smells and the fact it's a subfrontal lesion indicates we should look in the vicinity of the olfactory tract. We see from the angiogram that it's a picture of the left internal carotid distribution. There's a dark spot near the center slightly toward the lower left which looks like an aneurysm. If I had to take a guess it may be a berry aneurysm in the junction of the anterior communicating artery which is impinging on the olfactory tract. Since you didn't give any choices for complications I'll go with a subarachnoid hemorrhage.

 

[MudPhud20XX]

severe headache is a strong sign of increased intracranial pressure so we can try to look for a lesion causing mass effects. The perception of strange smells and the fact it's a subfrontal lesion indicates we should look in the vicinity of the olfactory tract. We see from the angiogram that it's a picture of the left internal carotid distribution. There's a dark spot near the center slightly toward the lower left which looks like an aneurysm. If I had to take a guess it may be a berry aneurysm in the junction of the anterior communicating artery which is impinging on the olfactory tract. Since you didn't give any choices for complications I'll go with a subarachnoid hemorrhage.

after reading your explanation it makes sense! thanks so much!

here is the solution:

Note the aneurysmal dilation located in the anterior communicating artery. Although the focal cerebral arterial medial weakness was present early in life, the berry aneurysm itself developed over time. Rupture of an intracranial aneurysm is a common cause for subarachnoid hemorrhage, as the cerebral arteries at the base of the brain, typically the circle of Willis, are in this location. Hypertension is not a risk for bleeding with aneurysms, but activities that increase intracranial pressure, such as straining and lifting, are risks.

 

[Robotman]

This is a great question OP.