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The SAH's Surgery!

Topic: Adult

Created on Friday, May 29 2009 by rednucleus

Last modified on Saturday, June 6 2009.

After properly stabilizing this 51-year-old woman with acute subarachnoid hemorrhage, you tell your interns to prepare her for surgical intervention. With respect to the surgical treatment of subarachnoid hemorrhage (SAH) due to ruptured Berry's aneurysm, which one is the incorrect statement?

 
        A) May involve clipping of the neck of the aneurysm
 
        B) It is used in patients who are fully conscious or mildly confused
 
        C) May include endovascular placement of a coil
 
        D) The optimal timing of surgery is still controversial
 
        E) Decerebrate posturing means that the patient should be operated upon quickly
 

 


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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) May involve clipping of the neck of the aneurysm

This answer is incorrect.


Surgical intervention is used in patients who are fully conscious or mildly confused; clinical grade I, II, and III. In those patients, surgery has been shown to improve the clinical outcome. The optimal timing of surgery is still controversial; however, current evidence supports an early intervention within 2 days post ictus. This approach reduces the period at risk for re-bleeding and permits aggressive treatment vasospasm with volume expansion and pharmacologic elevation of blood pressure. Patients who demonstrate decerebrate posturing have a bad outcome; active intervention is usually fruitless.   (See References)

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B) It is used in patients who are fully conscious or mildly confused

This answer is incorrect.


Surgical intervention is used in patients who are fully conscious or mildly confused; clinical grade I, II, and III. In those patients, surgery has been shown to improve the clinical outcome. The optimal timing of surgery is still controversial; however, current evidence supports an early intervention within 2 days post ictus. This approach reduces the period at risk for re-bleeding and permits aggressive treatment vasospasm with volume expansion and pharmacologic elevation of blood pressure. Patients who demonstrate decerebrate posturing have a bad outcome; active intervention is usually fruitless.   (See References)

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C) May include endovascular placement of a coil

This answer is incorrect.


Surgical intervention is used in patients who are fully conscious or mildly confused; clinical grade I, II, and III. In those patients, surgery has been shown to improve the clinical outcome. The optimal timing of surgery is still controversial; however, current evidence supports an early intervention within 2 days post ictus. This approach reduces the period at risk for re-bleeding and permits aggressive treatment vasospasm with volume expansion and pharmacologic elevation of blood pressure. Patients who demonstrate decerebrate posturing have a bad outcome; active intervention is usually fruitless.   (See References)

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D) The optimal timing of surgery is still controversial

This answer is incorrect.


Surgical intervention is used in patients who are fully conscious or mildly confused; clinical grade I, II, and III. In those patients, surgery has been shown to improve the clinical outcome. The optimal timing of surgery is still controversial; however, current evidence supports an early intervention within 2 days post ictus. This approach reduces the period at risk for re-bleeding and permits aggressive treatment vasospasm with volume expansion and pharmacologic elevation of blood pressure. Patients who demonstrate decerebrate posturing have a bad outcome; active intervention is usually fruitless.   (See References)

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E) Decerebrate posturing means that the patient should be operated upon quickly

This answer is correct.


Surgical intervention is used in patients who are fully conscious or mildly confused; clinical grade I, II, and III. In those patients, surgery has been shown to improve the clinical outcome. The optimal timing of surgery is still controversial; however, current evidence supports an early intervention within 2 days post ictus. This approach reduces the period at risk for re-bleeding and permits aggressive treatment vasospasm with volume expansion and pharmacologic elevation of blood pressure. Patients who demonstrate decerebrate posturing have a bad outcome; active intervention is usually fruitless.   (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 Surgery!
Question ID: 052909118
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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