Chapter 57C. Intracranial Aneurysms and Subarachnoid Hemorrhage

Question 1

Question 57C-1: 
Which imaging study is most sensitive for identification of  subarachnoid blood? 
A.  CT 
B.  CT angiography 
C.  MRI 
D.  MR angiography

Answer 1

Answer S7C-l: A.
Conventional CT is the most sensitive
imaging modality for detection of
subarachnoid hemorrhage. MRI and CT
angiography are sensitive for identification of
aneurysms, but they are less sensitive for
visualization of subarachnoid blood. (p1271)

Question 2

Question 57C-2: 
A patient found on MRI  performed for hemispheric stroke to have a fusiform aneurysm of  the basilar artery. This is not in the vascular  distribution to produce the presentmg symptoms. Which of  the following is the main risk of  this finding? 
A.  Subarachnoid hemorrhage 
B.  Intracerebral hemonbage 
C.  Infarction 
D.  Any ofthese

Answer 2

Answer 57C-2: C.
Fusiform aneurysms are rarely associated with
SAH. Rather, they have risk of infarction from
intraluminal clot or direct compression of
cranial nerves producing cranial nerve palsies.
(p1274)

Question 3

Question 57C-3: 
Which of the following is the most common complication of  SAH? 
A.  Cerebral infarction 
B.  Hydrocephalus 
C.  Recurrent hemorrhage 
D.  Seizures

Answer 3

Answer 57C-3: A.
Cerebral infarction is the most common
complication of SAH, with a rate of 27%.
Hydrocephalus develops in 12%, recurrent
hemorrhage in 11%, and seizures in 5%.
(P1275)

Question 4

Question 57C-4:
Which of the following are reasonable approaches for prevention and management of vasospasm in patients with SAH?
1. Nimodipine
2. Endovascular balloon dilatation
3. Maintenance of good cardiac output
4. Dehydration to minimize edema
Select: A = 1.2,3. B = I, 3.C=2,4.D =4 only. E=AII

Answer 4

Answer 57C-4: A.
Dehydration should be avoided in patients
with SAH. While we worry about
hypertension, dehydration is not the way to
reduce blood pressure. The rest are all
reasonable approaches to management of
vasospasm, although endovascular therapy is
not used by all clinicians. (p1280)

Question 5

Question 57C-5:
A patient presents witb subarachnoid hemorrhage and has angiography on the second hospital day that shows no visible aneurysm. How would you advise the patient regarding restudy?
A. Restudy is not warranted because of the negative cerebral angiogram
B. Restudy with cerebral angiography is needed 7-10 days later because of the possibility of missing an aneurysm on early angiography
C. Restudy with MRA is needed 1-2 weeks following the hemorrhage because of the risk of missing an aneurysm on early angiography

Answer 5

Answer 57C-5: B.
Early cerebral angiography is performed
because early intervention of cerebral
aneurysms is now recommended to prevent
rebleeding. Treatment of vasospasm is even
easier if there is not the concern over those
interventions producing rebleeding. Therefore,
restudy is indicated within 7-10 days, and
conventional angiography is superior to MRA.
(p1282)