Saccular aneurysm Quiz: Ace Your Exams

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A 40-year-old woman is brought to the emergency department for evaluation of an acute-onset, severe headache. The patient was preparing dinner when she suddenly lost consciousness and fell to the floor. Upon awakening, the patient endorsed “the worst headache of my life.” Her medical history is notable for a ventricular septal defect repaired during childhood. She is nauseated and has vomited twice. Temperature is 36.2°C (97.1°F), pulse is 100/min, and blood pressure is 150/90 mmHg. On physical examination, the patient appears in acute distress due to pain. Her pupils are equal and reactive to light. A non-contrast CT is shown below. Which of the following is the most likely etiology of this patient's clinical presentation?  


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