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The SAH's consequences!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

While you manage a 61-year-old woman with acute subarachnoid bleed, she develops certain complications. With respect to complications and sequelae of subarachnoid hemorrhage (SAH), which one is the wrong statement?

 
        A) Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure
 
        B) SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur
 
        C) Decorticate or decerebrate posturing are very rare and should point to an alternative diagnosis
 
        D) Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs
 
        E) Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus
 

 


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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) Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure

This answer is incorrect.


Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure; it is seen in 20% of cases from day 3-14. Recurrent bleeding from AVMs is less common in the acute period. Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs but rupture of a large aneurysm of then anterior or middle cerebral arteries may direct the jet of blood into the brain parenchyma producing hemiparesis, aphasia, and even transtentorial herniation. Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus; these may develop with the first day to several weeks after the ictus, due to impairment in CSF absorption. Decorticate or decerebrate posturing are common and may mistaken for "seizures". Seizures occur in 10% of cases and ONLY after damage to the underlying cerebral cortex. SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur; however, all of them are uncommon.   (See References)

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B) SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur

This answer is incorrect.


Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure; it is seen in 20% of cases from day 3-14. Recurrent bleeding from AVMs is less common in the acute period. Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs but rupture of a large aneurysm of then anterior or middle cerebral arteries may direct the jet of blood into the brain parenchyma producing hemiparesis, aphasia, and even transtentorial herniation. Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus; these may develop with the first day to several weeks after the ictus, due to impairment in CSF absorption. Decorticate or decerebrate posturing are common and may mistaken for "seizures". Seizures occur in 10% of cases and ONLY after damage to the underlying cerebral cortex. SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur; however, all of them are uncommon.   (See References)

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C) Decorticate or decerebrate posturing are very rare and should point to an alternative diagnosis

This answer is correct.


Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure; it is seen in 20% of cases from day 3-14. Recurrent bleeding from AVMs is less common in the acute period. Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs but rupture of a large aneurysm of then anterior or middle cerebral arteries may direct the jet of blood into the brain parenchyma producing hemiparesis, aphasia, and even transtentorial herniation. Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus; these may develop with the first day to several weeks after the ictus, due to impairment in CSF absorption. Decorticate or decerebrate posturing are common and may mistaken for "seizures". Seizures occur in 10% of cases and ONLY after damage to the underlying cerebral cortex. SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur; however, all of them are uncommon.  (See References)

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D) Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs

This answer is incorrect.


Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure; it is seen in 20% of cases from day 3-14. Recurrent bleeding from AVMs is less common in the acute period. Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs but rupture of a large aneurysm of then anterior or middle cerebral arteries may direct the jet of blood into the brain parenchyma producing hemiparesis, aphasia, and even transtentorial herniation. Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus; these may develop with the first day to several weeks after the ictus, due to impairment in CSF absorption. Decorticate or decerebrate posturing are common and may mistaken for "seizures". Seizures occur in 10% of cases and ONLY after damage to the underlying cerebral cortex. SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur; however, all of them are uncommon.   (See References)

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E) Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus

This answer is incorrect.


Recurrence of the subarachnoid bleed is the major acute complication and roughly doubles the mortality figure; it is seen in 20% of cases from day 3-14. Recurrent bleeding from AVMs is less common in the acute period. Intra-parenchymal extension of the bleed is less common in ruptured aneurysms when compared with ruptured AVMs but rupture of a large aneurysm of then anterior or middle cerebral arteries may direct the jet of blood into the brain parenchyma producing hemiparesis, aphasia, and even transtentorial herniation. Progressive somnolence, non-focal findings, and impaired up-gaze may suggest a complicating acute or subacute hydrocephalus; these may develop with the first day to several weeks after the ictus, due to impairment in CSF absorption. Decorticate or decerebrate posturing are common and may mistaken for "seizures". Seizures occur in 10% of cases and ONLY after damage to the underlying cerebral cortex. SIADH, cerebral salt wasting syndrome, and central diabetes insipidus may occur; however, all of them are uncommon.   (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 consequences!
Question ID: 052909095
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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