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Acute Neuro Care pp 195–208Cite as

Aneurysmal Subarachnoid Hemorrhage

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Abstract

A 64-year-old female was brought to the emergency department of a tertiary care center by his son. She was apparently alright till 10 h back when she complained of sudden onset of severe headache followed by two episodes of vomiting and transient loss of consciousness. She was a known hypertensive for last 15 years, on Tab amlodipine 10 mg BD. On examination, patient had a GCS score of E4V5M6 (drowsy), with pupils bilaterally equal in size and reacting to light. There was presence of neck rigidity with no other motor/sensory deficits. Heart rate—92/min, BP—178/102 mmHg, SpO2—95% on face mask with oxygen flow @ 6 L/min. Chest and CVS examination findings were normal. Samples for lab testing were sent. Noncontrast CT head revealed blood in the right sylvian fissure. Cerebral DSA was carried out which confirmed the presence of right middle cerebral artery (M1) aneurysm 5.23 × 3.42 × 2.32 mm.

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Author information

Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Charu Mahajan, Indu Kapoor & Hemanshu Prabhakar

Authors
  1. Charu Mahajan
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  2. Indu Kapoor
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  3. Hemanshu Prabhakar
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    A patient having moderate headache with nuchal stiffness belongs to which grade on Hunt and Hess scale?

    1. (a)

      I

    2. (b)

      II

    3. (c)

      III

    4. (d)

      IV

  2. 2.

    Which one is least likely to be present in a patient admitted with a history of aneurysmal SAH?

    1. (a)

      ECG abnormalities

    2. (b)

      Hyponatremia

    3. (c)

      Hypothermia

    4. (d)

      Hydrocephalus

  3. 3.

    The gold standard for the detection of ruptured cerebral aneurysms in acute SAH is

    1. (a)

      CT

    2. (b)

      MRA

    3. (c)

      CTA

    4. (d)

      DSA

  4. 4.

    Which of the following complications carries the highest mortality in acute SAH?

    1. (a)

      Rebleeding

    2. (b)

      Electrolyte abnormalities

    3. (c)

      ECG changes

    4. (d)

      Hyperthermia

  5. 5.

    The only proven pharmacological agent which improves outcome in patients having aneurysmal SAH is

    1. (a)

      Magnesium

    2. (b)

      Clazosentan

    3. (c)

      Nimodipine

    4. (d)

      Erythropoietin

  6. 6.

    Patient having aneurysmal bleed with large intraparenchymal hematoma is preferably taken up for

    1. (a)

      Surgical clipping

    2. (b)

      Coiling

    3. (c)

      Flow divertor placement

    4. (d)

      Conservative management

  7. 7.

    Which one is not true about antifibrinolytics administration in SAH?

    1. (a)

      Delay in definitive treatment is expected

    2. (b)

      Prevents vasospasm

    3. (c)

      Should be given for <72 h

    4. (d)

      May cause cerebral ischemia

  8. 8.

    Which one is true about seizures in SAH?

    1. (a)

      Prophylactic therapy should be given for 1 month.

    2. (b)

      Short course of anti-epileptic drugs <7 days may be considered.

    3. (c)

      Long-term use is associated with a good outcome.

    4. (d)

      Levetiracetam is proven to be better than phenytoin.

  9. 9.

    Which one is a feature of neurogenic stunned myocardium?

    1. (a)

      Troponin levels will be higher than that in MI

    2. (b)

      No past history of cardiac disease

    3. (c)

      Wall motion abnormalities correlating with coronary vascular distribution

    4. (d)

      Abnormal coronaries.

  10. 10.

    All are components of early brain injury except

    1. (a)

      Microthrombosis

    2. (b)

      Decreased glutamate

    3. (c)

      Cortical spreading depolarisation

    4. (d)

      High ET-1.

Answers: 1. (b), 2. (c), 3. (d), 4. (a), 5. (c), 6. (a), 7. (b), 8. (b), 9. (b), 10. (b).

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Mahajan, C., Kapoor, I., Prabhakar, H. (2020). Aneurysmal Subarachnoid Hemorrhage. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_11

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_11

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

  • eBook Packages: MedicineMedicine (R0)

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