Intracranial hemorrhage


All are risk factors for intracerebral hemorrhage except


A. Low levels of total serum cholesterol
B. Apolipoprotein E (APOE) gene
C. Premenopausal females
D. Alcohol withdrawal



Most common cause of spontaneous subarachnoid hemorrhage (SAH)


A. Perimesencephalic SAH
B. Aneurysms in the circle of Willis
C. Mycotic aneurysm
D. Pseudoaneurysms



Terson’s Syndrome includes


A. Subarachnoid hemorrhage (SAH) & foot drop
B. Painful third nerve palsy & intracerebral hemorrhage
C. Photophobia & ruptured aneurysm
D. SAH and vitreous hemorrhage



All are true regarding spontaneous subarachnoid hemorrhage (SAH) except


A. Negative CT scan will require LP
B. Perimesencephalic hemorrhage has a benign course
C. Aneurysmal SAH is rare in perimenopausal women
D. Ottawa SAH Rule has 100% sensitivity



Most rapid and readily available tool for the diagnosis of ICH is


A. Lumbar puncture
B. Noncontrast computerized tomography (CT)
C. CT Angiography (CTA)
D. MR angiography (MRA)



Not true of subarachnoid hemorrhage (SAH)


A. Xanthochromia in CSF is pathognomonic for SAH
B. If non-contrast head CT is not definitive the next recommended diagnostic tool is the LP
C. If MRI is negative for SAH, LP has no role
D. Prothrombin complex concentrate (PCC) is used for reversing anticoagulation



In Short


Factors associated with the risk of rupture of aneurysm include hypertension, tobacco use, excessive alcohol use, sympathomimetic drugs, Black race, Hispanic ethnicity, and aneurysmal size > 10 millimeters (mm).


Ottawa decision Rule excludes SAH if patients had a pattern of similar headaches, had papilledema, or focal neurologic deficits on exam, or had a prior history of aneurysm, SAH, neoplasm, or hydrocephalus.


CT/LP remains the most accepted rule-out method in SAH whereas noncontrast computerized tomography (CT) is the most rapid and readily available tool for the diagnosis of ICH.


If SBP is >200 mm Hg or MAP is >150 mm Hg, then consider aggressive reduction of BP in ICH.


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