Written by Adam Blumenberg MD
Special Thanks to Mark Silverberg MD
A 54 year-old woman with a history of cigarette smoking and uncontrolled hypertension presents to the ED disoriented and mumbling incomprehensible words. Her family members say she began acting strangely about 20 minutes after complaining of severe headache. Her blood pressure in the ED is 200/150mmHg, and heart rate is 65 beats per minute. Two slices of a CT of her head are shown above.
1. Please described the images
The images depict blood in the subarachnoid space. Blood is visible in the:
A. Supracellar cistern
B. Sylvian cisterns
C. Abutting the falx cerebri
D. Between cerebral gyri
E. In the fourth ventricle.
The “Starfish sign” is specific for subarachnoid hemorrhage.
2. What are the most common etiologies of this illness? Is the etiology of this patient’s illness identifiable?
These images show a berry aneurysm (F) arising from the left middle cerebral artery. The rupture of this aneurysm is likely the caused of this bleeding. The underlying etiology of the aneurysm is most likely uncontrolled hypertension.
3. What are the fundamental goals of managing this illness?
Management of intracranial hypertension
Prevention of vasospasm
Blood pressure control
4. What are the next steps in the management of this patient?
5. What is Cushing’s triad?
The triad consists of bradycardia, hypertension, and dysregulated respirations.
6. What is autoregulation?
7. What is this patient’s disposition?
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