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 |
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