Subarachnoid Hemorrhage

Question 1

Subarachnoid hemorrhage (SAH) is caused by the _____ that is usually located in the ____ portion of the______.

Answer 1

rupture of an aneurysm

anterior
circle of Willis

Question 2

Aneurysms are present in __% of routine autopsies. And The vast majority _____.

Answer 2

2

never rupture.

Question 3

aneurysm are more frequent in those with:

Answer 3

• Polycystic kidney disease
• Tobacco smoking
• Hypertension
• Hyperlipidemia
• High alcohol consumption

Question 4

What provokes a rupture is:

Answer 4

is not clear in the majority of cases.

Question 5

“What Is the Most Likely Diagnosis?” CxFx

Answer 5

• extremely severe headache (of sudden onset)
• meningeal irritation
• fever
• 50%Loss of consciousness
• 30%Focal neurological findings.

Question 6

meningeal irritation includes:

Answer 6

stiff neck, photophobia

Question 7

Why fever?

Answer 7

Fever is secondary to blood

irritating the meninges.

Question 8

How SAH differs from meningitis on CxFx?

Answer 8

Very sudden in onset

Loss of consciousness

Question 9

why Loss of consciousness?

Answer 9

from the sudden increase in intracranial pressure

Question 10

Best initial test:

Answer 10

CT without contrast (95% sensitive)

Question 11

Most accurate test:

Answer 11

Lumbar puncture showing blood

Question 12

_____ is a yellow discoloration of CSF from the ____

Answer 12

Xanthochromia

breakdown of red blood cells (RBCs)

Question 13

when is LP necessary?

Answer 13

LP is necessary only for the 5% that have a falsely negative CT scan.

Question 14

The CSF in SAH will have _____, which can mimic meningitis. However, the ratio of_____ will be normal in ___. When the ___ exceeds the normal ratio, you should suspect ___.

Answer 14

an increased number of WBCs

WBCs to RBCs
SAH

WBC count
meningitis

Question 15

Normal ratio: One WBC for every _____

Answer 15

500 to 1,000 RBCs

Question 16

The EKG may show___

. And why?

Answer 16

large or inverted T waves suggestive of myocardial ischemia (cerebral T waves).

This is thought to be from excessive sympathetic activity.

Question 17

Contrast on CT or MRI improves detection of:

Answer 17

mass lesions such as cancer or abscess. Don’t use contrast when looking for blood.

Question 18

____ is used to determine the site of the aneurysm in order to____

Answer 18

Angiography
to guide repair of the lesion.

CT angiography,
standard angiography with a catheter, or MRA.

Question 19

SAH Treatment can be summarized in 4 aspects

Answer 19

1. -Nimodipine
2. -Embolization (coiling)
3. • Ventriculoperitoneal shunt*
4. -Seizure prophylaxis

Question 20

why Nimodipine

Answer 20

(calcium channel blocker) prevents subsequent ischemic stroke.

Question 21

Embolization is superior to

_____ in terms of survival and complications.

Answer 21

surgical clipping

Question 22

How does Embolization work?

Answer 22

it uses a catheter to “clog up” the site of bleeding to prevent a repeated hemorrhage. An interventional neuroradiologist places platinum wire into the site of hemorrhage.

Question 23

when to use Ventriculoperitoneal shunt?

Answer 23

only if hydrocephalus develops

Question 24

what to give for Seizure prophylaxis:

Answer 24

Phenytoin

Question 25

“Consultation” is the right answer only when:

Answer 25

you want to do a particular procedure and the procedure is not given as a choice.