Which condition is associated with traumatic or ruptured berry aneurysm, the worst headache of life, nuchal rigidity, and lethargy?

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This item tests recognition of subarachnoid hemorrhage from rupture of a saccular (berry) aneurysm. When such an aneurysm bursts, blood quickly fills the subarachnoid space, producing a sudden, severe headache often described as the worst headache of life. Blood in the subarachnoid space irritates the meninges, leading to neck stiffness (nuchal rigidity) and other signs of meningeal irritation; lethargy or altered consciousness can follow as the bleed progresses or raises intracranial pressure.

Cerebellar hemorrhage typically presents with ataxia, dizziness, imbalance, and gradual or focal neurological symptoms rather than the abrupt thunderclap headache with meningismus. Anton syndrome and Balint syndrome are chronic, bilateral cortical visual‑processing disorders, not acute hemorrhagic presentations, so they don’t fit this scenario.