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Focal physical findings in patients with subarachnoid hemorrhage

Focal physical findings in patients with subarachnoid hemorrhage
Findings Likely cause
Third nerve palsy Usually posterior communicating aneurysm; also posterior cerebral artery and superior cerebellar artery aneurysms
Sixth nerve palsy Elevated intracranial pressure (false localizing sign)
Combination of hemiparesis and aphasia or visuospatial neglect Middle cerebral artery aneurysm, thick subarachnoid clots, or parenchymal hematomas
Bilateral leg weakness and abulia Anterior communicating artery aneurysm
Ophthalmoplegia Internal carotid artery aneurysm impinging upon the cavernous sinus
Unilateral visual loss or bitemporal hemianopia Internal carotid artery aneurysm compressing optic nerve or optic chiasm
Impaired level of consciousness and impaired upward gaze Pressure on the dorsal midbrain due to hydrocephalus
Brainstem signs Brainstem compression by basilar artery aneurysm
Neck stiffness Meningeal irritation by the presence of subarachnoid blood
Retinal and subhyaloid hemorrhages Sudden increase of intracranial pressure
Preretinal hemorrhages (Terson syndrome) Vitreous hemorrhage due to severe elevations of intracranial pressure
From: Suarez JI. Diagnosis and Management of Subarachnoid Hemorrhage. Continuum (Minneap Minn) 2015; 21:1263. DOI: 10.1212/CON.0000000000000217. Copyright © 2015 American Academy of Neurology. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
Graphic 121321 Version 2.0

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