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subarachnoid hemorrhage

Practice targeted AMC-style multiple-choice questions on subarachnoid hemorrhage.

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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 62-year-old patient presented with a subarachnoid haemorrhage secondary to a ruptured cerebral aneurysm and underwent endovascular coiling. They have recovered well and are on routine follow-up. The image shows a recent angiogram performed as part of their surveillance. Considering the findings, what is the MOST appropriate next step in this patient's management?

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A 65-year-old man undergoes successful coil embolization of a ruptured anterior communicating artery aneurysm. Two days post-procedure, he develops a temperature of 38.1°C, generalized malaise, and a headache unresponsive to paracetamol. Neurological exam is unchanged from baseline. CRP is 45 mg/L (normal <5). Which of the following is the most likely cause of his current symptoms?

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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 55-year-old patient presented with a subarachnoid haemorrhage from a ruptured cerebral aneurysm, which was successfully treated with endovascular coiling. They have made a good recovery. The image shows a routine follow-up angiogram performed 6 months post-procedure. Based on the findings demonstrated in the image, what is the MOST appropriate next step in this patient's management?

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A 40-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress, with a blood pressure of 180/110 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the most appropriate next step in the management of this patient?

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A 45-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress due to the headache. His blood pressure is 180/110 mmHg, heart rate is 90 bpm, and he has no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the next best step in management?

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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 55-year-old patient presents with a subarachnoid haemorrhage from a ruptured posterior cerebral artery aneurysm. Endovascular coiling is performed without immediate complications. The image shows the post-procedure angiogram obtained before leaving the angiography suite. Based on this finding, what is the MOST appropriate next step in management?

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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal subarachnoid hemorrhage is confirmed. The aneurysm was coiled. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

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A 65-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on antihypertensive medication. On examination, he is alert but in distress due to the headache. His blood pressure is 180/110 mmHg, heart rate is 90 bpm, and he has no focal neurological deficits. A CT scan of the head shows a subarachnoid hemorrhage. Which of the following is the most appropriate initial management step in this patient?

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A 45-year-old woman presents to the emergency department with sudden onset of severe headache, described as the worst headache of her life. She also reports nausea and photophobia. Her past medical history is significant for hypertension, which is poorly controlled. On examination, she is alert but in distress, with a blood pressure of 180/110 mmHg, heart rate of 90 bpm, and temperature of 37°C. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head is performed and shows no acute intracranial hemorrhage. What is the next best step in management?

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