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H+P (Exam 3) Neuro Assessment Lecture > Cerebral Aneurysm & SAH > Flashcards

Cerebral Aneurysm & SAH Flashcards

1
Q

How often are cerebral aneurysms diagnosed before rupture?

A

The majority of aneurysms are not diagnosed before rupture.

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2
Q

What percentage of aneurysm patients experience symptoms before rupture?

A

Only about one third of aneurysm patients have symptoms before rupture.

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3
Q

What are the common symptoms of cerebral aneurysms before rupture?

A
  • headache
  • photophobia
  • confusion
  • hemiparesis
  • coma.

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4
Q

What are the risk factors associated with cerebral aneurysms?

A
  • hypertension
  • smoking
  • being female
  • oral contraceptive use
  • cocaine use

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5
Q

How are cerebral aneurysms diagnosed?

A
  • CT angiography
  • MRI
  • lumbar puncture with CSF analysis if rupture is suspected

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6
Q

When should intervention for a ruptured cerebral aneurysm be performed?

A

** within 72 hours** of rupture for the best outcomes.

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7
Q

Why is glucose monitoring important for patients with cerebral aneurysms?

A

Patients may be on steroids, making glucose monitoring important.

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8
Q

What are the pre-anesthesia considerations for a patient with a cerebral aneurysm?

A
  • CT/MRI
  • EKG
  • echocardiogram
  • CBC
  • BMP
  • type and crossmatch with blood available.

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9
Q

What is important in the pre-anesthesia management of blood pressure in cerebral aneurysm patients?

A

To control blood pressure to avoid rupture

(perhap use Mannitol?)

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10
Q

What prophylactic measures should be considered pre-anesthesia in cerebral aneurysm patients?

A

Seizure prophylaxis

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11
Q

What are the surgical treatment options for cerebral aneurysms?

A
  • coiling
  • stenting
  • trapping/bypass (for very large aneurysms.)

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12
Q

Why might a neurosurgeon be on standby during operations on patients with cerebral aneurysms?

A

in case of intraoperative rupture or subarachnoid hemorrhage (SAH).

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13
Q

When is the risk for vasospasm highest after a subarachnoid hemorrhage (SAH)?

A

The risk for vasospasm is highest 3-15 days post-SAH.

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14
Q

What is triple H therapy in the context of post-SAH management?

A
  • Hypertension
  • Hypervolemia
  • Hemodilution

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15
Q

What is initially the main treatment to avoid complications of hypervolemia?

A

Hypertension is the initial main treatment to avoid complications of hypervolemia.

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16
Q

What interventional treatments are used to relieve vasospasm?

A

Interventional treatments such as :
* balloon dilation
* direct injection of vasodilators are used to relieve the spasm

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17
Q

What pre-anesthesia interventions are similar between managing cerebral aneurysms and post-SAH?

A

interventions same as with aneurysm, although normally they are less-invasive.

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18
Q

What does a score of 0 on the Hunt and Hess classification indicate?

A

An unruptured aneurysm with a mortality rate of 0%-2%.

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19
Q

What are the findings and mortality rate for a score of 1 on the Hunt and Hess classification?

A

A ruptured aneurysm with minimal headache and no neurologic deficits, with a mortality rate of 2%-5%.

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20
Q

What does a score of 2 on the Hunt and Hess classification signify?

A

A ruptured aneurysm with moderate to severe headache, no deficit other than cranial nerve palsy, and a mortality rate of 5%-10%.

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21
Q

How is a score of 3 on the Hunt and Hess classification characterized?

A

Drowsiness, confusion, or mild focal motor deficit, with a mortality rate of 5%-10%.

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22
Q

What does a Hunt and Hess score of 4 represent?

A

Stupor, significant hemiparesis, early decerebration, with a mortality rate of 25%-30%.

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23
Q

What does a score of 5 on the Hunt and Hess classification indicate in terms of patient condition and mortality rate?

A

Deep coma, decerebrate rigidity, with a mortality rate of 40%-50%.

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24
Q

In the World Federation of Neurologic Surgeons grading system, what does a score of 1 represent?

A

A Glasgow Coma Scale score of 15 with no presence of major focal deficit and an intact, unruptured aneurysm.

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25
Q

What does a score of 2 or 3 on the World Federation of Neurologic Surgeons grading system indicate?

A

A Glasgow Coma Scale score of 13 or 14 with no presence of major focal deficit for a score of 2, and possible presence for a score of 3.

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26
Q

How is a score of 4 on the World Federation of Neurologic Surgeons grading system defined?

A

A Glasgow Coma Scale score of 7-12, with the presence of a major focal deficit being possible or not.

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27
Q

What does a score of 5 on the World Federation of Neurologic Surgeons grading system imply?

A

A Glasgow Coma Scale score of 3-6 with the presence of a major focal deficit being possible or not.

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H+P (Exam 3) Neuro Assessment Lecture (15 decks)

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