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A 53-year-old right-handed woman developed left pulsatile tinnitus. One year later she presented with a severe occipital headache with neck stiffness while defecating. On admission to hospital she was normotensive (blood pressure 120/70 mm Hg), with a Glasgow coma scale score of 15/15. Examination showed meningism but no focal features.
CT scan of head showed a linear periventricular haemorrhage, centred upon the posterior aspect of the corpus callosum (figure 1A) with intraventricular haemorrhage. An MR scan of the brain 1 year before (when she had presented with left pulsatile tinnitus) had shown left internal carotid artery occlusion (figure 1B) and left hemisphere signal change, consistent with a watershed infarction (figure 1C). The same MR scan also showed extensive collateralisation from the left internal carotid artery occlusion, including prominent vessels in the corpus callosum (figure 1D).
A CT …
Contributors BM wrote the first draft and performed a literature search. PF conceived the idea, provided the neuroimaging figures and revised previous drafts. PJK provided neuroimaging and revised drafts of the paper. FM helped write the paper and revise previous drafts. MOM had the idea of writing the paper, performed a literature search, helped write the first draft and subsequent reviews.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Martin Punter, Salford, UK.