Aneurysms, Hemorrhages, and Hematomas

Question 1

a weak spot in an artery that can rupture with any force, leading to a hemorrhage

Answer 1

cerebral aneurysm

Question 2

what is the clinical presentation of an aneurysm?

Answer 2

asymptomatic until rupture

Question 3

what is the probability of aneurysm rupture related to?

Answer 3

the size of the aneurysm

Question 4

what is most commonly identified with screening and has a low risk for rupture?

Answer 4

small aneurysm less than 6 mm in diameter

Question 5

patients with ruptured aneurysms less than ____ mm have a better prognosis

Answer 5

10

Question 6

in which case is screening for a cerebral aneurysm necessary?
what screening will be done?

Answer 6

family history in two 1st degree relatives

CTA head or MRA head at 20 yo + every 5-10 years

Question 7

incidental aneurysm are treated at which diameter?

Answer 7

over 7-10 mm

Question 8

in which 5 instances would an incidental aneurysm especially be treated?

Answer 8

posterior circulation aneurysm
+ daughter sac (weak point)
young age
hx of SAH
family hx of SAH

Question 9

what are 2 treatment options for a cerebral aneurysm?

Answer 9

clipping
coiling

Question 10

what are most SAH caused by?

Answer 10

ruptured aneurysm

Question 11

a patient presents with a “thunderclap” headache and they say its the worst headache of their life. they have meningismus/stiff neck, photophobia, N/V, and loss of consciousness. what are they experiencing?

Answer 11

subarachnoid hemorrhage

Question 12

what diagnostic would we use for a subarachnoid hemorrhage?
how would it look?

Answer 12

CT head without contrast
white = blood

Question 13

what diagnostic can be done if a head CT without contrast is negative but we still suspect SAH?

Answer 13

LP

Question 14

what is the management of a SAH? (2)

Answer 14

treat aneurysm by neurosx
lower BP

Question 15

what is the goal for BP in a patient with SAH?

Answer 15

systolic BP < 160

Question 16

what would be given to prevent a vasospasm and delayed ischemia in a patient with a SAH? (3)

Answer 16

transcranial doppler
nimodipine x 21 days
statins while in ICU

Question 17

what 2 conditions would we want to avoid in a patient with a SAH?

Answer 17

hyperthermia
hyperglycemia

Question 18

how should a patient with a SAH be placed to reduce ICP?

Answer 18

head elevated at 30

Question 19

ruptured vein that runs between the dura and cortex of brain tissue

Answer 19

subdural hematoma

Question 20

what is a subdural hematoma commonly caused by?

Answer 20

head trauma

Question 21

a patient presents with headache, confusion, irritability, and papilledema. what are they experiencing?

Answer 21

subdural hematoma

Question 22

what diagnostic should be done for a patient with suspicious subdural hematoma?

Answer 22

CT head without contrast

Question 23

what is the management/treatment for a subdural hematoma? (4)

Answer 23

neurosx consult
mannitol to lower ICP
head elevation at 30
fix any coagulopathy

Question 24

bleeding between the dura mater and the skill, what is usually associated with ruptured arteries

Answer 24

epidural hematoma

Question 25

which artery is most commonly affect in an epidural hematoma?

Answer 25

middle meningeal artery

Question 26

what is an epidural hematoma associated with?

Answer 26

skull fracture

Question 27

what is the most serious complication of head trauma?

Answer 27

epidural hematoma

Question 28

what is the treatment for an epidural hematoma?

Answer 28

immediate surgery