Med 4

Question 1

Subarachnoid space

Answer 1

• The space between Arachnoid matter and Pia mater

- Contains cerebrospinal fluid and major blood vessels

Question 2

Subarachnoid hemorrhage

Answer 2

Bleeding in the basal cisterns

Bleeding in the subarachnoid spaces

Question 3

How does the Subarachnoid hemorrhage appears on CT scan?

Answer 3

Appears as hyperdense area

Question 4

Subarachnoid hemorrhage Appears as hyperdense area on CT scan:

Answer 4

 Surrounding the brain stem
 In the Sylvian (lateral) fissure
 Anterior interhemispheric fissure

Question 5

Basal cisterna:

Answer 5

 Dilatation of the subarachnoid space

 Found mainly around the brain stem

Question 6

What are the four main basal cisterna?

Answer 6

1- Anterior: interpeduncular cistern
2- Posterior: quadrigeminal cistern
3- Lateral: two ambient cisterna

Question 7

شكل الsubarachnoid haemorrhage

Answer 7

Diffuse sunburst appearance

Star sign = “death star”

Question 8

Epidural hemorrhage

Answer 8

Banana-like hemorrhage

Concave along the convexity

Question 9

Subdural hemorrhage

Answer 9

Lemon-like hemorrhage

Biconvex hemorrhage

Question 10

Signs and symptoms of SAH

Answer 10

Headache
Nausea and vomiting
Drowsiness and loss of consciousness
Meningeal signs are positive

Question 11

Headache

Answer 11

Headache is the main presenting symptom
Described as the worst headache in the entire life
Sudden onset thunderclap headache

Question 12

Meningeal signs are positive:

Answer 12

 Nuchal rigidity
 Kernig’s sign
 Brudzinski’s sign

Question 13

Kernig sign:

Answer 13

Supine
Knee is flexed to 90 degrees
Hip is flexed to 90 degrees
Extension of the knee is painful or limited in extension

Question 14

Brudzinski sign:

Answer 14

Passive flexion of neck

Patient: elicits hip and knee flexion

Question 15

Causes of SAH

Answer 15

Traumatic

Spontaneous (non-traumatic)

Question 16

the most common cause of SAH in general is

Answer 16

Traumatic

Question 17

Spontaneous (non-traumatic)

Answer 17

Berry (saccular) aneurysm
Arteriovenous malformation (AVM)

Question 18

the most common cause of spontaneous SAH is

Answer 18

Berry (saccular) aneurysm

Question 19

the 2nd most common cause of spontaneous SAH

Answer 19

Arteriovenous malformation (AVM)

Question 20

The most common artery to be affected by berry (saccular) aneurysm

Answer 20

 In general: anterior communicating artery
 In the anterior circulation: anterior communicating artery
 In the posterior circulation: tip of basilar artery

Question 21

The most important factor in development and rupture of aneurysms and in stroke is

Answer 21

HTN

Question 22

Types of aneurysms

Answer 22

Saccular aneurysm

Fusiform aneurysm

Question 23

Saccular aneurysm:

Answer 23

associated with SAH

Question 24

Fusiform aneurysm:

Answer 24

associated with dissection of ICA

Question 25

Diagnosis of SAH

Answer 25

The golden standard investigation is non-contrast CT scan | If non-contrast CT is inconclusive then we do lumbar puncture (LP)

Question 26

The golden standard investigation is non-contrast CT scan:

Answer 26

 Can detect SAH in 95 – 96% in the first 48 hours |  In 4-5% of cases, CT scan to be normal (doesn’t exclude SAH)

Question 27

If non-contrast CT is inconclusive then we do lumbar puncture (LP):

Answer 27

To confirm the diagnosis of SAH if non-contrast CT is normal

Question 28

What we will find when we do LP?

Answer 28

``` Blood is uniform in all tubes RBC count is also uniform Blood doesn’t clot on standing Pink or yellow supernatant Increased CSF pressure Increased CSF protein ```

Question 29

Investigation to determine the cause of SAH

Answer 29

4 Vessel angiograms (conventional carotid and cerebral angiography) MRA (Magnetic resonance angiography) CTA (Computed Tomography Angiogram)

Question 30

procedure of choice for evaluation of brain aneurysm

Answer 30

4 Vessel angiograms (conventional carotid and cerebral angiography

Question 31

The main complications of SAH

Answer 31

- Re-bleeding | - Vasospasm

Question 32

Management of aneurysm

Answer 32

Surgical clipping | Endovascular coiling

Question 33

Surgical clipping:

Answer 33

 The first option in treatment of aneurysm  A surgical clip can be applied to the neck of the aneurysm  A surgical clip will separate the aneurysm from the circulation

Question 34

Endovascular coiling:

Answer 34

 The second option in treatment of aneurysm  The sac of aneurysm is obliterated by insertion of surgical coils  A surgical coil will separate the aneurysm from the circulation