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Blood around the brain!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

You suspect non-traumatic subarachnoid hemorrhage in this middle-aged woman because of sudden thunder-clap headache and drowsiness. You order brain imaging to solidify your initial impression. Regarding spontaneous subarachnoid hemorrhage (SAH), which one is the wrong statement?

 
        A) Brain MRI may be used to detect small brainstem AVMs
 
        B) Brain MRI sensitivity increases day by day after the ictus
 
        C) Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable
 
        D) The sensitivity of the brain CT scan rises gradually day by day after the ictus
 
        E) Non-contrast brain CT scan is the most sensitive initial investigation
 

 


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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) Brain MRI may be used to detect small brainstem AVMs

This answer is incorrect.


Non-contrast brain CT scan is the most sensitive in the initial investigation; it is positive in 90% of cases, especially in patients with impaired consciousness. It may show a subarachnoid bleed, intra-parenchymal extension, intra-ventricular blood or hydrocephalus, and even cerebral infarction. It is rapid and available at many hospitals and suitable for unstable patients. However, it may not show the aneurysm itself unless it is large enough. Brain MRI may be used to detect small brainstem AVMs (these can not be seen by CT scans). The sensitivity of the brain CT scan declines gradually day by day after the ictus (from 90% in the first day down to less than 40% after 5 days post ictus). Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable; in addition, it is time consuming, not available at all centers, and has many contraindications. Brain MRI sensitivity increases day by day after the ictus; rises from less than 50% within the first 3 days to more than 80% 5 days post-ictus. NB: If the initial CT scan is normal and the clinical index is high, the next step should be lumbar puncture and CSF analysis.  (See References)

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B) Brain MRI sensitivity increases day by day after the ictus

This answer is incorrect.


Non-contrast brain CT scan is the most sensitive in the initial investigation; it is positive in 90% of cases, especially in patients with impaired consciousness. It may show a subarachnoid bleed, intra-parenchymal extension, intra-ventricular blood or hydrocephalus, and even cerebral infarction. It is rapid and available at many hospitals and suitable for unstable patients. However, it may not show the aneurysm itself unless it is large enough. Brain MRI may be used to detect small brainstem AVMs (these can not be seen by CT scans). The sensitivity of the brain CT scan declines gradually day by day after the ictus (from 90% in the first day down to less than 40% after 5 days post ictus). Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable; in addition, it is time consuming, not available at all centers, and has many contraindications. Brain MRI sensitivity increases day by day after the ictus; rises from less than 50% within the first 3 days to more than 80% 5 days post-ictus. NB: If the initial CT scan is normal and the clinical index is high, the next step should be lumbar puncture and CSF analysis.  (See References)

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C) Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable

This answer is incorrect.


Non-contrast brain CT scan is the most sensitive in the initial investigation; it is positive in 90% of cases, especially in patients with impaired consciousness. It may show a subarachnoid bleed, intra-parenchymal extension, intra-ventricular blood or hydrocephalus, and even cerebral infarction. It is rapid and available at many hospitals and suitable for unstable patients. However, it may not show the aneurysm itself unless it is large enough. Brain MRI may be used to detect small brainstem AVMs (these can not be seen by CT scans). The sensitivity of the brain CT scan declines gradually day by day after the ictus (from 90% in the first day down to less than 40% after 5 days post ictus). Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable; in addition, it is time consuming, not available at all centers, and has many contraindications. Brain MRI sensitivity increases day by day after the ictus; rises from less than 50% within the first 3 days to more than 80% 5 days post-ictus. NB: If the initial CT scan is normal and the clinical index is high, the next step should be lumbar puncture and CSF analysis.  (See References)

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D) The sensitivity of the brain CT scan rises gradually day by day after the ictus

This answer is correct.


Non-contrast brain CT scan is the most sensitive in the initial investigation; it is positive in 90% of cases, especially in patients with impaired consciousness. It may show a subarachnoid bleed, intra-parenchymal extension, intra-ventricular blood or hydrocephalus, and even cerebral infarction. It is rapid and available at many hospitals and suitable for unstable patients. However, it may not show the aneurysm itself unless it is large enough. Brain MRI may be used to detect small brainstem AVMs (these can not be seen by CT scans). The sensitivity of the brain CT scan declines gradually day by day after the ictus (from 90% in the first day down to less than 40% after 5 days post ictus). Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable; in addition, it is time consuming, not available at all centers, and has many contraindications. Brain MRI sensitivity increases day by day after the ictus; rises from less than 50% within the first 3 days to more than 80% 5 days post-ictus. NB: If the initial CT scan is normal and the clinical index is high, the next step should be lumbar puncture and CSF analysis.  (See References)

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E) Non-contrast brain CT scan is the most sensitive initial investigation

This answer is incorrect.


Non-contrast brain CT scan is the most sensitive in the initial investigation; it is positive in 90% of cases, especially in patients with impaired consciousness. It may show a subarachnoid bleed, intra-parenchymal extension, intra-ventricular blood or hydrocephalus, and even cerebral infarction. It is rapid and available at many hospitals and suitable for unstable patients. However, it may not show the aneurysm itself unless it is large enough. Brain MRI may be used to detect small brainstem AVMs (these can not be seen by CT scans). The sensitivity of the brain CT scan declines gradually day by day after the ictus (from 90% in the first day down to less than 40% after 5 days post ictus). Brain MRI is not preferred as the initial diagnostic tool because the patient may be irritable; in addition, it is time consuming, not available at all centers, and has many contraindications. Brain MRI sensitivity increases day by day after the ictus; rises from less than 50% within the first 3 days to more than 80% 5 days post-ictus. NB: If the initial CT scan is normal and the clinical index is high, the next step should be lumbar puncture and CSF analysis.  (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
Blood around the brain!
Question ID: 052909081
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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