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17 Cards in this Set
- Front
- Back
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What are the 2 Main Classification Systems for SAH?
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1. WFNS ( World Federation of Neurological Surgeons)
2. Hunt and Hess |
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What are the categories of the WFNS Scale for SAH?
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Grade I = GCS 15 No motor deficit
Grade II = GCS 13-14 No motor deficit Grade III = GCS 13-14 with motor deficit Grade IV = GCS 7-12 +/- motor deficit Grade V = GCS 3-6 +/- motor deficit |
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In regards to the WFNS scoring for SAH, which of the following is incorrect?
A. It incorporates the GCS B. A GCS of 13-14 with motor deficit = Grade III C. Grade V = GCS 6-8 D. GCS 13-14 without motor deficit = Grade II |
C Grade V = GCS 3-6
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What are the categories for the Hunt and Hess scoring system for SAH?
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Grade I = Asymptomatic / mild headache / nuchal rigidity
Grade II = Moderate-severe headache Nuchal rigidity Cranial nerve palsy Grade III = Drowsy / confused / mild focal deficit Grade IV = Stupor / Hemiparesis / vegetative Grade V = Deep coma / decerebrate |
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In regards to the WFNS and Hunt + Hess scores for SAH, which is incorrect?
A. Grade I-II Hunt and Hess outcomes are >90% independence and 1-2 % death rate B. Grade IV-V Hunt and Hess has 80% mortality C. Grades I-II for both WFNS and H+H are similar, with GCS 13-15, with no motor deficit. D. The WFNS Scale is preferred over the H+H in Australasia. |
C. Grade II : H+H can have cranial nerve palsy
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Which of the following is incorrect regarding SAH?
A. The most common age group for SAH is age 40-60 B. Non-aneurysmal SAH occurs in <5% of cases of SAH. C. Posterior circulation aneurysms are more likely to rupture (compared with anterior circulation). D. Sickle cell disease is a risk factor for SAH. |
B. 10%
85% of SAH is rom a ruptured cerebral aneurysm. |
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Which of the following is correct regarding SAH?
A. 1 in 6 patients presenting with sudden severe headache will have SAH. B. Up to 75% of patients with SAH will have a "Warning Leak " (Sentinel haemorrhage). C. 66% of patients develop SAH during sleep / routine ADL. D. Seizures occur in 5% cases SAH. |
C.
A. 1 in 4 B. 50% D. 15% |
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Which is correct regarding SAH?
A. 75% patients will have impaired level of consciousness on presentation. B. 25% patients can have focal Neurological deficits. C. Subhyaloid haemorrhages, but not papilloedema, can be seen with SAH. D. Raised ICP in SAH can give a 3rd nerve palsy. |
B.
A. 66% C. Both can D. usually gives 6th nerve palsy 3rd nerve palsy is from PCOM aneurysm compressing the oculomotor nerve. Bilateral LL weakness can occur from an ACOM aneurysm. |
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In regards to investigations for SAH, which of the following is incorrect?
A. The diagnostic sensitivity of CTB for SAH at 24-48 hours is 92-95 % B. The diagnostic sensitivity of CTB for SAH within 6 hours on a 3rd generation scanner is 97-100% C. 3% of patients with SAH will have a normal CT brain. D. CT angiography has a sensitivity of 95% for locating aneurysmal source of a SAH. |
A. 80-86%
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Which of the following is incorrect regarding SAH Investigations ?
A. The haemoglobin breakdown products oxyhaemoglobin and bilirubin cause xanthochromia. B. The most sensitive means of detecting xanthochromia is spectrophotometry. C. Traumatic tap occurs in 15% of lumbar punctures. D. Xanthochromia is present in all patients at 6 hours post SAH bleed. |
D. Typically take > 12 hours.
Controversial as to when LP should be performed based on this- weighed against the risk of a rebelled in this time. |
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List the Early Complications of an acute SAH bleed.
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1. Rebleeding ( 15% -hours ; -40% -4 weeks )
2. Intracerebral haematoma / subdural (SDH) 3. Cerebral vasospasm 4. Hydrocephalus 5. Seizures 6. Fluid / electrolyte disturbances -hyponatraemia 7. Pulmonary oedema 8. Cardiac arrhythmias |
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Which is incorrect regarding late complications of SAH?
A. Late Re-bleeding at a rate of 1-3 % B. Epilepsy 15% C. Cognitive deficits D. Anosmia 30% |
B. Epilepsy 5-7%
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In regards to Cerebral vasospasm in SAH, which of the following is incorrect?
A. It is a major cause of morbidity and mortality. B. It occur between 3 hours and 3 days post SAH bleed. C. Clinically significant vasospasm occurs in 20% of SAH. D. The best predictor of vasospasm is the amount of blood seen on the initial CT. |
B. Between 3 days and 15 days
Peak onset day 6-8 |
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Which is correct regarding SAH?
A. Hydrocephalus is seen in 5% SAH. B. Cerebral vasospasm peaks at 6 hours post SAH bleed. C. Hyponatraemia can occur due to cerebral salt wasting , or SIADH. D. Pulmonary oedema occurs in up to 23% cases of SAH. |
C.
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Which is incorrect regarding SAH Management?
A. Antihypertensive therapy is reserved for patients with a MAP > 130 mmHg. B. An EVD may be required for SAH with hydrocephalus. C. Endovascular coiling is preferred over Surgical clipping. D. The calcium antagonist, Nimodipine, is commenced at 60 mg IV avery 4 hours after Dx of SAH. |
D. 60 mg orally every 4 hours after Dx SAH
Continued for 3 weeks. |
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Which is incorrect regarding SAH?
A. The most important prognostic factor is the Clinical condition of the patient at presentation. B. The survival rate for Grade I SAH is 70%. C. Vascular imaging is required for patients presenting after more than 1 week post onset of symptoms. D. Endovascular coiling has an absolute risk reduction of 7% for death / severe disability at 1 year, when compared with Surgical clipping. |
C. > 2 weeks post onset with normal CT and LP -
- CT angiography vs. MRI with flair. |
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In regards to Perry et al's 2011 BMJ Paper on SAH Investigations, which of the following is incorrect?
A. It was a Prospective, Multicentre, Cohort study in Ottawa, Canada. B. It suggests that CT performed on a 3rd Generation scanner within 6 hours of severe headache onset, has a 100% sensitivity and specificity for detecting SAH. C. The 3rd Generation 320 slice CT scanners include 5-7.5 mm cuts in the posterior fossa, and 7.5 -10mm cuts for the rest of the brain. D. 240 of the 3132 patients had confirmed SAH by CT +/- LP. |
C. 2.5 - 5mm cuts in the posterior fossa
5-7.5 mm for the rest of the brain |
