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The SAH's therapy!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

Your interns ask you about the optimal medical treatment of this 62-year-old man with acute subarachnoid hemorrhage. Your reply does NOT include which one of the following statements

 
        A) Vasospasm should be treated by induced hypertension with phenylephrine or dopamine
 
        B) Prophylactic anticonvulsants should be avoided until seizures occur
 
        C) Risk of vasospasm may be reduced with cautious administration of normal saline, 3 L/day
 
        D) Intravenous fluids, when are being given, should be iso-osmotic
 
        E) Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm
 

 


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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) Vasospasm should be treated by induced hypertension with phenylephrine or dopamine

This answer is incorrect.


Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm; given as 60 mg, 6 times daily, for 21 days. Vasospasm should be treated by induced hypertension with phenylephrin or dopamine but this intervention is more safely performed after definitive surgical treatment of the ruptured aneurysm. Anticonvulsants should be given prophylactically (e.g. pheytoin 300 mg/day) because seizures increase the risk of re-bleeding. Intravenous fluids, when given, should be iso-osmotic to avoid the development of brain edema.   (See References)

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B) Prophylactic anticonvulsants should be avoided until seizures occur

This answer is correct.


Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm; given as 60 mg, 6 times daily, for 21 days. Vasospasm should be treated by induced hypertension with phenylephrin or dopamine but this intervention is more safely performed after definitive surgical treatment of the ruptured aneurysm. Anticonvulsants should be given prophylactically (e.g. pheytoin 300 mg/day) because seizures increase the risk of re-bleeding. Intravenous fluids, when given, should be iso-osmotic to avoid the development of brain edema.   (See References)

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C) Risk of vasospasm may be reduced with cautious administration of normal saline, 3 L/day

This answer is incorrect.


Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm; given as 60 mg, 6 times daily, for 21 days. Vasospasm should be treated by induced hypertension with phenylephrin or dopamine but this intervention is more safely performed after definitive surgical treatment of the ruptured aneurysm. Anticonvulsants should be given prophylactically (e.g. pheytoin 300 mg/day) because seizures increase the risk of re-bleeding. Intravenous fluids, when given, should be iso-osmotic to avoid the development of brain edema.   (See References)

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D) Intravenous fluids, when are being given, should be iso-osmotic

This answer is incorrect.


Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm; given as 60 mg, 6 times daily, for 21 days. Vasospasm should be treated by induced hypertension with phenylephrin or dopamine but this intervention is more safely performed after definitive surgical treatment of the ruptured aneurysm. Anticonvulsants should be given prophylactically (e.g. pheytoin 300 mg/day) because seizures increase the risk of re-bleeding. Intravenous fluids, when given, should be iso-osmotic to avoid the development of brain edema.   (See References)

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E) Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm

This answer is incorrect.


Prophylactic use of nimodipine has been shown to decrease the cerebral ischemic sequelae of cerebral vasospasm; given as 60 mg, 6 times daily, for 21 days. Vasospasm should be treated by induced hypertension with phenylephrin or dopamine but this intervention is more safely performed after definitive surgical treatment of the ruptured aneurysm. Anticonvulsants should be given prophylactically (e.g. pheytoin 300 mg/day) because seizures increase the risk of re-bleeding. Intravenous fluids, when given, should be iso-osmotic to avoid the development of brain edema.   (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 therapy!
Question ID: 052909090
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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