Differentials
Arteriovenous malformation
SIGNS / SYMPTOMS
Subacute presentation.
Presents more often with seizures.
INVESTIGATIONS
Brain CT and/or MRI of the brain will show an arteriovenous malformation.
Hypertensive intra-cerebral haemorrhage
SIGNS / SYMPTOMS
Age >55 years.
History of hypertension.
Headache with focal neurological deficit.
INVESTIGATIONS
Diagnostic cerebral angiography will be normal.
CT or MRI of the brain will show a focal haematoma more typical for a hypertensive haemorrhage.
Cerebral venous sinus thrombosis
SIGNS / SYMPTOMS
Middle-aged woman.
Subacute presentation.
May have known hypercoagulable state.
Papilloedema seen on examination.
INVESTIGATIONS
Diagnostic cerebral angiography will show slow arteriovenous transit if there is venous hypertension, and a flow defect in a major sinus.
Pattern of haemorrhage on CT or MRI will be adjacent to cortical vein or sinus.
Traumatic subarachnoid haemorrhage
SIGNS / SYMPTOMS
Older patient with a fall.
Headaches are usually less severe.
INVESTIGATIONS
CT will show haemorrhage focused along the bony contour, sometimes with an associated skull fracture.
Haemorrhagic tumour
SIGNS / SYMPTOMS
History of primary malignancy, particularly lung or renal carcinoma.
INVESTIGATIONS
CT or MRI may show a mass with surrounding haemorrhage.
A thrombosed aneurysm may produce surrounding oedema and haemorrhage mimicking a mass.
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