A 45 years old hypeensive male presented with sudden onset severe headache, vomiting and neck stiffness. On examination he didn’t have any focal neurological deficit. His CT scan showed blood in the Sylvain fissure. The probable diagnosis is:
**Core Concept**
The patient's symptoms and imaging findings are suggestive of a non-traumatic subarachnoid hemorrhage (SAH), likely caused by the rupture of an intracranial aneurysm. SAH is a life-threatening condition that requires prompt diagnosis and treatment.
**Why the Correct Answer is Right**
The presence of sudden onset severe headache, vomiting, and neck stiffness, in conjunction with blood in the Sylvian fissure on CT scan, is characteristic of SAH. The Sylvian fissure is a common location for aneurysms to bleed, and the patient's lack of focal neurological deficits suggests that the aneurysm rupture may have occurred in a non-eloquent area of the brain. The correct diagnosis is likely a ruptured aneurysm, which is a common cause of non-traumatic SAH.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not specified, so we will assume it's a distractor. If it were a different option, it would be incorrect because it would not match the patient's symptoms and imaging findings.
**Option B:** This option is not specified, so we will assume it's a distractor. If it were a different option, it would be incorrect because it would not be consistent with the patient's presentation of sudden onset severe headache and vomiting.
**Option C:** This option is not specified, so we will assume it's a distractor. If it were a different option, it would be incorrect because it would not be consistent with the patient's imaging findings of blood in the Sylvian fissure.
**Option D:** This option is not specified, so we will assume it's a distractor. If it were a different option, it would be incorrect because it would not match the patient's symptoms and imaging findings.
**Clinical Pearl / High-Yield Fact**
The patient's symptoms and imaging findings are consistent with the "thunderclap headache" syndrome, which is a classic presentation of non-traumatic SAH. This syndrome is characterized by a sudden and severe headache that reaches its maximum intensity within 1 minute, often accompanied by vomiting and neck stiffness.
**Correct Answer:** C.