SAH from Cerebral Aneurysm Rupture Flashcards
Aneurysms tend to arise in areas where there is a curve in the parent artery, in the angle between it and a significant branching artery, and point in the direction where the parent artery would have continued had the curve not been present. Also, there is less elastic fiber in the tunica media and adventitia of cerebral blood vessels, the media has less muscle, the adventitia is thinner, and the internal elastic lamina is more prominent. Following are the possible etiologies of aneurysms formation except?
● A. Congenital predisposition
● B. Atherosclerotic changes or hypertension
● C. Embolic
● D. Infectious which are also called as mycotic aneurysms
● E. Trauma is never a cause of aneurysm development
E. Trauma is never a cause of aneurysm development
Saccular aneurysms most commonly occur in the carotid system which accounts for about 85 to 90% of aneurysms, while posterior circulation accounts for 5 to 15% of aneurysms. What is the single most common location of aneurysm (which constitutes 30% of aneurysms)?
● A. AComA
● B. pComA
● C. Middle cerebral artery
● D. Basilar artery
● E. Vertebral artery
A. AComA
Intraventricular hemorrhage occurs in 13 to 28% of cases of ruptured aneurysms in clinical series. Which of the following statements is incorrect regarding intraventricular hemorrhage and aneurysm location?
● A. Distal PICA aneurysm may rupture directly into the 4th ventricle through the foramen of Luschka
● B. AComA cause IVH by rupturing through the lamina terminalis into the anterior 3rd ventricle or lateral ventricles
● C. Distal basilar artery may rupture through the floor of the 3rd ventricle
● D. Middle cerebral artery aneurysm may rupture through the temporal horn of ventricle
● E. Carotid terminus artery aneurysm may rupture through the floor of the 3rd ventricle
D. Middle cerebral artery aneurysm may rupture through the temporal horn of ventricle
Oculomotor 3rd nerve palsy occurs mostly in which aneurysm which can result in extraocular muscle palsy, ptosis, and dilated unreactive pupil?
● A. Basilar apex aneurysm
● B. PComA aneurysms
● C. PICA aneurysms
● D. AICA aneurysms
● E. None of the above
B. PComA aneurysms
Which of the following are the endovascular techniques to treat aneurysm?
● A. Thrombosing the aneurysm using coiling with Guglielmi electrolytically detachable coils
● B. Thrombosing the aneurysm using Onyx 500 for wide neck or giant ICA aneurysms
● C. Using flow diversion with covered stents
● D. Trapping which can be done by distal and proximal arterial interruption using endovascular techniques
● E. All of the above
E. All of the above
What is the surgical gold standard for aneurysm treatment?
● A. Coiling through endovascular technique
● B. Clipping the aneurysm
● C. Wrapping or coating the aneurysm using muscle or cotton or muslin
● D. Coating the aneurysm using Teflon or fibrin glue
● E. None of the above
B. Clipping the aneurysm
Microsurgical clipping is favorable in patients with intraparenchymal hematomas, favorable dome–neck ratio, younger age, and middle cerebral artery aneurysm. Endovascular coiling may receive increased consideration in which of the following cases?
● A. Elderly patients with age more than 70 years
● B. Those with poor grade WFNS classification
● C. Those with aneurysms of basilar apex
● D. In patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping, endovascular coiling should be considered
● E. All of the above
E. All of the above
Early surgery after rupture of aneurysm is advocated because it eliminates the risk of rebleeding (which occurs mostly in period immediately post SAH), it facilitates treatment of vasospasm, and it allows lavage to remove potentially vasospasmogenic agent from contact with vessels, including use of thrombolytic agents. Which of the following are the arguments against early surgery in favor of late surgery?
● A. Inflammation and brain edema are most severe immediately post SAH which can damage brain tissue during manipulation
● B. Large clot with mass effect associated with SAH
● C. The presence of solid clot that has not had time to lyse impedes surgery
● D. The risk of intraoperative rupture is higher with early surgery
● E. Incidence of vasospasm possibly increase after early surgery from mechanotrauma to vessels
B. Large clot with mass effect associated with SAH
Which of the following are the techniques that can be adopted using surgical exposure for aneurysm surgery?
● A. Brain relaxation using hyperventilation, CSF drainage (done only after opening the dura), and diuretics
● B. Cerebral protection by increasing the ischemic tolerance of the CNS using calcium channel blockers, free radical scavengers, and mannitol
● C. Reducing cerebral rate of oxygen consumption by using barbiturates, isoflurane, and prophylactic hypothermia
● D. Using adjunctive cerebral protection techniques using systemic hypotension or focal hypotension by using temporary clips
● E. All of the above
E. All of the above
Which of the following statements is correct regarding the use of temporary clips using aneurysm surgery?
● A. If a long segment of the ICA is being trapped, administer 5,000 unit IV heparin to prevent thrombosis and subsequent emboli
● B. If temporary clip is applied for less than 5 minutes, then there is no need of further intervention
● C. If temporary clip is applied for 10 to 15 minutes, then administration of IV brain protection anesthesia has been shown to significantly decrease infarction rate with intermittent reperfusion
● D. More than 20 minutes of temporary clip is not tolerated
● E. All of the above
E. All of the above
Which is the single most common location of cerebral aneurysms?
● A. Acomm
● B. ACA
● C. MCA
● D. Pcomm
● E. VA-PICA junction
A. Acomm
What is the incidence of spontaneous thrombosis of an aneurysm?
● A. 3 to 6%
● B. 6 to 9%
● C. 9 to 13%
● D. 15 to 18%
● E. 19 to 21%
C. 9 to 13%
A 50-year-old hypertensive patient was referred from DHQ for further management of SAH. Plain CT of brain shows blood predominantly in prepontine and peduncular cisterns and the third ventricle. This suggests aneurysm location as which of the following?
● A. Anterior communicating artery
● B. Anterior cerebral artery
● C. Posterior communicating artery
● D. Middle cerebral srtery
● E. Basilar apex
E. Basilar apex
A middle-aged smoker presented with sudden-onset severe headache followed by seizures and loss of consciousness. Which of the following aneurysm by location is most commonly associated with seizures?
● A. Anterior communicating artery
● B. Posterior communicating artery
● C. Posterior inferior cerebellar artery
● D. Middle cerebral artery
● E. Anterior cerebral artery
D. Middle cerebral artery
Facial pain syndromes in the ophthalmic or maxillary nerve distribution that may mimic trigeminal neuralgia can occur with aneurysm in which of the following?
● A. Intracavernous ICA
● B. ACA
● C. AComm
● D. Anterior choroidal artery
● E. pcomm
A. Intracavernous ICA
