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The SAH's Work-Up!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

You are taking care of a patient with acute subarachnoid hemorrhage. Regarding the investigations in subarachnoid hemorrhage (SAH), which one is the wrong statement?

 
        A) Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done
 
        B) Cerebral 4-vessel angiography is preferred to be done in patients with a deep coma
 
        C) The ECG may reveal a host of abnormalities
 
        D) Brain MRA may miss small aneurysms
 
        E) Cerebral 4-vessel angiogram may be totally normal
 

 


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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) Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done

This answer is incorrect.


The 12-lead ECG may reveal a host of abnormalities, like peaked or deeply inverted T wave, short PR interval, or a tall U wave. The cardiac troponins may be raised as well. These occur due to a massive catecholamine release which may damage the myocardium. Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done to visualize the whole cerebral vasculature. The aneurysm is multiple in 20% of cases, and AVMs may have multiple feeding vessels. Angiography can be performed at the earliest time convenient for the radiology department personnel (emergency angiography at the middle of the night is rarely indicated). Angiography is a prerequisite to the rational planning of surgical treatment and is therefore not necessary for patients who are "not surgical candidates", e.g. those who are deeply comatose. A cerebral 4-vessel angiogram may be totally normal and the causes are: the aneurysm may be sealed off by a clot, the aneurysm may be very small, bleeding from a venous angioma, bleeding from a cavernous angioma, and bleeding from a spinal source. Brain MRA may miss small aneurysms; hence, it is used mainly for screening purposes.  (See References)

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B) Cerebral 4-vessel angiography is preferred to be done in patients with a deep coma

This answer is correct.


The 12-lead ECG may reveal a host of abnormalities, like peaked or deeply inverted T wave, short PR interval, or a tall U wave. The cardiac troponins may be raised as well. These occur due to a massive catecholamine release which may damage the myocardium. Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done to visualize the whole cerebral vasculature. The aneurysm is multiple in 20% of cases, and AVMs may have multiple feeding vessels. Angiography can be performed at the earliest time convenient for the radiology department personnel (emergency angiography at the middle of the night is rarely indicated). Angiography is a prerequisite to the rational planning of surgical treatment and is therefore not necessary for patients who are "not surgical candidates", e.g. those who are deeply comatose. A cerebral 4-vessel angiogram may be totally normal and the causes are: the aneurysm may be sealed off by a clot, the aneurysm may be very small, bleeding from a venous angioma, bleeding from a cavernous angioma, and bleeding from a spinal source. Brain MRA may miss small aneurysms; hence, it is used mainly for screening purposes.  (See References)

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C) The ECG may reveal a host of abnormalities

This answer is incorrect.


The 12-lead ECG may reveal a host of abnormalities, like peaked or deeply inverted T wave, short PR interval, or a tall U wave. The cardiac troponins may be raised as well. These occur due to a massive catecholamine release which may damage the myocardium. Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done to visualize the whole cerebral vasculature. The aneurysm is multiple in 20% of cases, and AVMs may have multiple feeding vessels. Angiography can be performed at the earliest time convenient for the radiology department personnel (emergency angiography at the middle of the night is rarely indicated). Angiography is a prerequisite to the rational planning of surgical treatment and is therefore not necessary for patients who are "not surgical candidates", e.g. those who are deeply comatose. A cerebral 4-vessel angiogram may be totally normal and the causes are: the aneurysm may be sealed off by a clot, the aneurysm may be very small, bleeding from a venous angioma, bleeding from a cavernous angioma, and bleeding from a spinal source. Brain MRA may miss small aneurysms; hence, it is used mainly for screening purposes.  (See References)

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D) Brain MRA may miss small aneurysms

This answer is incorrect.


The 12-lead ECG may reveal a host of abnormalities, like peaked or deeply inverted T wave, short PR interval, or a tall U wave. The cardiac troponins may be raised as well. These occur due to a massive catecholamine release which may damage the myocardium. Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done to visualize the whole cerebral vasculature. The aneurysm is multiple in 20% of cases, and AVMs may have multiple feeding vessels. Angiography can be performed at the earliest time convenient for the radiology department personnel (emergency angiography at the middle of the night is rarely indicated). Angiography is a prerequisite to the rational planning of surgical treatment and is therefore not necessary for patients who are "not surgical candidates", e.g. those who are deeply comatose. A cerebral 4-vessel angiogram may be totally normal and the causes are: the aneurysm may be sealed off by a clot, the aneurysm may be very small, bleeding from a venous angioma, bleeding from a cavernous angioma, and bleeding from a spinal source. Brain MRA may miss small aneurysms; hence, it is used mainly for screening purposes.  (See References)

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E) Cerebral 4-vessel angiogram may be totally normal

This answer is incorrect.


The 12-lead ECG may reveal a host of abnormalities, like peaked or deeply inverted T wave, short PR interval, or a tall U wave. The cardiac troponins may be raised as well. These occur due to a massive catecholamine release which may damage the myocardium. Once the diagnosis is made, a conventional cerebral 4-vessel angiography should be done to visualize the whole cerebral vasculature. The aneurysm is multiple in 20% of cases, and AVMs may have multiple feeding vessels. Angiography can be performed at the earliest time convenient for the radiology department personnel (emergency angiography at the middle of the night is rarely indicated). Angiography is a prerequisite to the rational planning of surgical treatment and is therefore not necessary for patients who are "not surgical candidates", e.g. those who are deeply comatose. A cerebral 4-vessel angiogram may be totally normal and the causes are: the aneurysm may be sealed off by a clot, the aneurysm may be very small, bleeding from a venous angioma, bleeding from a cavernous angioma, and bleeding from a spinal source. Brain MRA may miss small aneurysms; hence, it is used mainly for screening purposes.  (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 SAH's Work-Up!
Question ID: 052909084
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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