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What can we do without Mr. Berry?

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

You intend to give a lecture to post-graduate neurology trainees about subarachnoid hemorrhage (SAH). Which one of the following statements should your lecture NOT include?

 
        A) About 15% of Berry aneurysms are located in the anterior communicating artery
 
        B) The aneurysmal hemorrhage is very commonly associated with focal cerebral signs at onset
 
        C) The rupture of a Berry aneurysm rapidly elevates the intracranial pressure
 
        D) The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance
 
        E) The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure
 

 


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This question was created on May 29, 2009 by rednucleus.
This question was last modified on June 06, 2009.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) About 15% of Berry aneurysms are located in the anterior communicating artery

This answer is incorrect.


The sudden rupture of a Berry aneurysm rapidly elevates the intracranial pressure and distorts the pain-sensitive structures causing severe headache. The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure and acutely reduce the cerebral blood flow; this together with "convulsive" effect of the rupture, are thought to be responsible for the sudden loss of consciousness at onset, which is observed in at least 50% of patients. The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance; sub-hyaloid pre-retinal hemorrhages are seen in up to 20% of cases. The subachnoid bleed is located outside the brain parynchyma; focal cerebral signs are UNCOMMON at onset, and the exceptions to this are: massive hemorrhage with extension into the underlying brain parenchyma, large aneurysms in the middle cerebral artery, and ruptured AVMs.  (See References)

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B) The aneurysmal hemorrhage is very commonly associated with focal cerebral signs at onset

This answer is correct.


The sudden rupture of a Berry aneurysm rapidly elevates the intracranial pressure and distorts the pain-sensitive structures causing severe headache. The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure and acutely reduce the cerebral blood flow; this together with "convulsive" effect of the rupture, are thought to be responsible for the sudden loss of consciousness at onset, which is observed in at least 50% of patients. The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance; sub-hyaloid pre-retinal hemorrhages are seen in up to 20% of cases. The subachnoid bleed is located outside the brain parynchyma; focal cerebral signs are UNCOMMON at onset, and the exceptions to this are: massive hemorrhage with extension into the underlying brain parenchyma, large aneurysms in the middle cerebral artery, and ruptured AVMs.  (See References)

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C) The rupture of a Berry aneurysm rapidly elevates the intracranial pressure

This answer is incorrect.


The sudden rupture of a Berry aneurysm rapidly elevates the intracranial pressure and distorts the pain-sensitive structures causing severe headache. The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure and acutely reduce the cerebral blood flow; this together with "convulsive" effect of the rupture, are thought to be responsible for the sudden loss of consciousness at onset, which is observed in at least 50% of patients. The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance; sub-hyaloid pre-retinal hemorrhages are seen in up to 20% of cases. The subachnoid bleed is located outside the brain parynchyma; focal cerebral signs are UNCOMMON at onset, and the exceptions to this are: massive hemorrhage with extension into the underlying brain parenchyma, large aneurysms in the middle cerebral artery, and ruptured AVMs.  (See References)

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D) The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance

This answer is incorrect.


The sudden rupture of a Berry aneurysm rapidly elevates the intracranial pressure and distorts the pain-sensitive structures causing severe headache. The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure and acutely reduce the cerebral blood flow; this together with "convulsive" effect of the rupture, are thought to be responsible for the sudden loss of consciousness at onset, which is observed in at least 50% of patients. The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance; sub-hyaloid pre-retinal hemorrhages are seen in up to 20% of cases. The subachnoid bleed is located outside the brain parynchyma; focal cerebral signs are UNCOMMON at onset, and the exceptions to this are: massive hemorrhage with extension into the underlying brain parenchyma, large aneurysms in the middle cerebral artery, and ruptured AVMs.  (See References)

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E) The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure

This answer is incorrect.


The sudden rupture of a Berry aneurysm rapidly elevates the intracranial pressure and distorts the pain-sensitive structures causing severe headache. The raised intracranial pressure may be very high and may even exceed the cerebral perfusion pressure and acutely reduce the cerebral blood flow; this together with "convulsive" effect of the rupture, are thought to be responsible for the sudden loss of consciousness at onset, which is observed in at least 50% of patients. The rapid elevation in the intracranial pressure is supposed to be responsible for the abnormal eye fundal appearance; sub-hyaloid pre-retinal hemorrhages are seen in up to 20% of cases. The subachnoid bleed is located outside the brain parynchyma; focal cerebral signs are UNCOMMON at onset, and the exceptions to this are: massive hemorrhage with extension into the underlying brain parenchyma, large aneurysms in the middle cerebral artery, and ruptured AVMs.  (See References)

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References:

1. Victor, M., and Ropper, A.H. (2005). Adams and Victor's Principles of Neurology, 8th Edition. McGraw-Hill, New York. (ISBN:007141620X) Advertising:
2. Aminoff, M.A., Greenberg, D.A., Simon, R.P. (2005). Clinical Neurology, 6th Edition. McGraw-Hill, New York. (ISBN:0071423605)Advertising:
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adult
What can we do without Mr. Berry?
Question ID: 052909066
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 05/29/2009
Modified: 06/06/2009
Estimated Permutations: 120

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