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Subarachnoid Bleed!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

A 45-year-old female has been referred to your ER as a suspected case of subarachnoid hemorrhage. Your interns ask you few questions about this type of hemorrhagic stroke. With regard to non-traumatic subarachnoid hemorrhage (SAH), which one is the wrong statement?

 
        A) Total absence of headache essentially preclude the diagnosis
 
        B) History of a mild preceding headache may be present
 
        C) Symptoms may begin at any time of the day
 
        D) The classical presentation is a sudden onset of unusually severe headache
 
        E) Loss of consciousness is uncommon at the time of the ictus
 

 


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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) Total absence of headache essentially preclude the diagnosis

This answer is incorrect.


The classical presentation is that of a sudden onset of unusually severe headache; it is classical but not invariable. Total absence of headache is against the diagnosis; however, the headache needs not to be so severe, e.g. mild headache is usually seen in ruptured AVMs, but should be present. At least 50% of patients lose their consciousness at the time of the onset of bleeding; vomiting and neck stiffness are also common. Symptoms may begin at any time of the day and during either at rest or exertion. Sentinel headache due to mild leaking or aneurysmal stretch may precede the full-blown rupture. NB: The most significant feature of the headache is that it is NEW, milder but otherwise similar headaches may have occurred in the weeks prior to the acute event. These prior headaches are probably the result of small prodromal sentinel bleeds or aneurysmal stretch.   (See References)

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B) History of a mild preceding headache may be present

This answer is incorrect.


The classical presentation is that of a sudden onset of unusually severe headache; it is classical but not invariable. Total absence of headache is against the diagnosis; however, the headache needs not to be so severe, e.g. mild headache is usually seen in ruptured AVMs, but should be present. At least 50% of patients lose their consciousness at the time of the onset of bleeding; vomiting and neck stiffness are also common. Symptoms may begin at any time of the day and during either at rest or exertion. Sentinel headache due to mild leaking or aneurysmal stretch may precede the full-blown rupture. NB: The most significant feature of the headache is that it is NEW, milder but otherwise similar headaches may have occurred in the weeks prior to the acute event. These prior headaches are probably the result of small prodromal sentinel bleeds or aneurysmal stretch.   (See References)

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C) Symptoms may begin at any time of the day

This answer is incorrect.


The classical presentation is that of a sudden onset of unusually severe headache; it is classical but not invariable. Total absence of headache is against the diagnosis; however, the headache needs not to be so severe, e.g. mild headache is usually seen in ruptured AVMs, but should be present. At least 50% of patients lose their consciousness at the time of the onset of bleeding; vomiting and neck stiffness are also common. Symptoms may begin at any time of the day and during either at rest or exertion. Sentinel headache due to mild leaking or aneurysmal stretch may precede the full-blown rupture. NB: The most significant feature of the headache is that it is NEW, milder but otherwise similar headaches may have occurred in the weeks prior to the acute event. These prior headaches are probably the result of small prodromal sentinel bleeds or aneurysmal stretch.   (See References)

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D) The classical presentation is a sudden onset of unusually severe headache

This answer is incorrect.


The classical presentation is that of a sudden onset of unusually severe headache; it is classical but not invariable. Total absence of headache is against the diagnosis; however, the headache needs not to be so severe, e.g. mild headache is usually seen in ruptured AVMs, but should be present. At least 50% of patients lose their consciousness at the time of the onset of bleeding; vomiting and neck stiffness are also common. Symptoms may begin at any time of the day and during either at rest or exertion. Sentinel headache due to mild leaking or aneurysmal stretch may precede the full-blown rupture. NB: The most significant feature of the headache is that it is NEW, milder but otherwise similar headaches may have occurred in the weeks prior to the acute event. These prior headaches are probably the result of small prodromal sentinel bleeds or aneurysmal stretch.   (See References)

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E) Loss of consciousness is uncommon at the time of the ictus

This answer is correct.


The classical presentation is that of a sudden onset of unusually severe headache; it is classical but not invariable. Total absence of headache is against the diagnosis; however, the headache needs not to be so severe, e.g. mild headache is usually seen in ruptured AVMs, but should be present. At least 50% of patients lose their consciousness at the time of the onset of bleeding; vomiting and neck stiffness are also common. Symptoms may begin at any time of the day and during either at rest or exertion. Sentinel headache due to mild leaking or aneurysmal stretch may precede the full-blown rupture. NB: The most significant feature of the headache is that it is NEW, milder but otherwise similar headaches may have occurred in the weeks prior to the acute event. These prior headaches are probably the result of small prodromal sentinel bleeds or aneurysmal stretch.   (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
Subarachnoid Bleed!
Question ID: 052909074
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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