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The Sub-Spider Meninges

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

A 55-year-old woman is brought to the ER by her husband. The husband states that his wife had a sudden severe occipital headache which is then followed by clouded consciousness. You examine the patient thoroughly and you consider subarachnoid hemorrhage. Regarding this hemorrhagic stroke, which one is the incorrect statement?

 
        A) Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days
 
        B) The systemic arterial blood pressure frequently drop precipitously as a result of hemorrhage
 
        C) A recrudescent headache usually signifies a recurrent bleeding episode
 
        D) Signs of meningeal irritation are very common
 
        E) The body temperature may reach 39 C during the first 2 weeks
 

 


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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) Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days

This answer is incorrect.


Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days and then usually subsides slowly over the next 2 weeks. A recrudescent headache usually signifies a recurrent bleeding episode; this doubles the mortality figure. The systemic arterial blood pressure rises very rapidly and may reach a very high level; hypertensive encephalopathy may be diagnosed instead! The body temperature may reach 39 C during the first 2 weeks, and together with signs of meningeal irritation, a diagnosis of pyogenic meningitis is usually made (wrongly). Signs of meningeal irritation are very common but are usually absent in the first few hours of the ictus. NB: Bilateral up-going toes and VI cranial nerve palsy are common, BUT these do not bear any relationship to the site of the ruptured aneurysm. Acute oculomotor nerve palsy is an uncommon finding in posterior communicating artery aneurysms and localizes the ruptured site. Ruptured AVMs also may localize the ruptured site by giving focal cerebral hemispheric signs.   (See References)

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B) The systemic arterial blood pressure frequently drop precipitously as a result of hemorrhage

This answer is correct.


Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days and then usually subsides slowly over the next 2 weeks. A recrudescent headache usually signifies a recurrent bleeding episode; this doubles the mortality figure. The systemic arterial blood pressure rises very rapidly and may reach a very high level; hypertensive encephalopathy may be diagnosed instead! The body temperature may reach 39 C during the first 2 weeks, and together with signs of meningeal irritation, a diagnosis of pyogenic meningitis is usually made (wrongly). Signs of meningeal irritation are very common but are usually absent in the first few hours of the ictus. NB: Bilateral up-going toes and VI cranial nerve palsy are common, BUT these do not bear any relationship to the site of the ruptured aneurysm. Acute oculomotor nerve palsy is an uncommon finding in posterior communicating artery aneurysms and localizes the ruptured site. Ruptured AVMs also may localize the ruptured site by giving focal cerebral hemispheric signs.   (See References)

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C) A recrudescent headache usually signifies a recurrent bleeding episode

This answer is incorrect.


Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days and then usually subsides slowly over the next 2 weeks. A recrudescent headache usually signifies a recurrent bleeding episode; this doubles the mortality figure. The systemic arterial blood pressure rises very rapidly and may reach a very high level; hypertensive encephalopathy may be diagnosed instead! The body temperature may reach 39 C during the first 2 weeks, and together with signs of meningeal irritation, a diagnosis of pyogenic meningitis is usually made (wrongly). Signs of meningeal irritation are very common but are usually absent in the first few hours of the ictus. NB: Bilateral up-going toes and VI cranial nerve palsy are common, BUT these do not bear any relationship to the site of the ruptured aneurysm. Acute oculomotor nerve palsy is an uncommon finding in posterior communicating artery aneurysms and localizes the ruptured site. Ruptured AVMs also may localize the ruptured site by giving focal cerebral hemispheric signs.   (See References)

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D) Signs of meningeal irritation are very common

This answer is incorrect.


Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days and then usually subsides slowly over the next 2 weeks. A recrudescent headache usually signifies a recurrent bleeding episode; this doubles the mortality figure. The systemic arterial blood pressure rises very rapidly and may reach a very high level; hypertensive encephalopathy may be diagnosed instead! The body temperature may reach 39 C during the first 2 weeks, and together with signs of meningeal irritation, a diagnosis of pyogenic meningitis is usually made (wrongly). Signs of meningeal irritation are very common but are usually absent in the first few hours of the ictus. NB: Bilateral up-going toes and VI cranial nerve palsy are common, BUT these do not bear any relationship to the site of the ruptured aneurysm. Acute oculomotor nerve palsy is an uncommon finding in posterior communicating artery aneurysms and localizes the ruptured site. Ruptured AVMs also may localize the ruptured site by giving focal cerebral hemispheric signs.   (See References)

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E) The body temperature may reach 39 C during the first 2 weeks

This answer is incorrect.


Although the duration of the bleed is very brief, the intensity of the headache may remain unchanged for several days and then usually subsides slowly over the next 2 weeks. A recrudescent headache usually signifies a recurrent bleeding episode; this doubles the mortality figure. The systemic arterial blood pressure rises very rapidly and may reach a very high level; hypertensive encephalopathy may be diagnosed instead! The body temperature may reach 39 C during the first 2 weeks, and together with signs of meningeal irritation, a diagnosis of pyogenic meningitis is usually made (wrongly). Signs of meningeal irritation are very common but are usually absent in the first few hours of the ictus. NB: Bilateral up-going toes and VI cranial nerve palsy are common, BUT these do not bear any relationship to the site of the ruptured aneurysm. Acute oculomotor nerve palsy is an uncommon finding in posterior communicating artery aneurysms and localizes the ruptured site. Ruptured AVMs also may localize the ruptured site by giving focal cerebral hemispheric signs.   (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
The Sub-Spider Meninges
Question ID: 052909077
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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