A dilemma

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    23-Feb-2016

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A dilemma. Zeus: Male of undetermined age who works as King of the Gods HOPC: Sudden onset, excruciatingly severe headache Precipitating factors: Straining on the toilet PMHx: Longstanding hypertension SHx: 40 pack year smoking Hx, regular ETOH (3-4 std. drinks/day). - PowerPoint PPT Presentation

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A dilemma..

A dilemma..

Zeus: Male of undetermined age who works as King of the GodsHOPC: Sudden onset, excruciatingly severe headachePrecipitating factors: Straining on the toilet PMHx: Longstanding hypertensionSHx: 40 pack year smoking Hx, regular ETOH (3-4 std. drinks/day)Q: What are the critical differentials you must consider in this scenario?

Hint: There are 2..A: Zeus is pregnant with his daughter Athena in his head and is getting serious labour contractions

OR!!!!!!!!!!!!!!!!!!!!!!SUBARACHNOID HAEMORRHAGE

Subarachnoid HaemorrhageDEFINITION: ?

Q: What is subarachnoid haemorrhage?Subarachnoid HaemorrhageA: DEFINITION: Spontaneous bleeding into the subarachnoid space of meninges. The area between the arachnoid mater and the pia mater.Q: This space usually contains what?

9

A: CSFZeus asks you: So what caused this headache in the first place?

Q: What is the most common cause of SAH?Causes/pathophysiologyA: 80-85% of cases result from rupture of an aneurysm, which tend to be located in the Circle of Willis.Risk factors for SAH include:Familial disposition to SAH First degree relatives of SAH patients, are 3-7 times more likely to be afflicted.Metabolic syndrome: hypertension, atherosclerosisLifestyle factors: smoking, alcohol abuseThe remainder of SAH cases are due to non-aneurysmal disorders of blood vessels, e.g.:Arteriovenous malformation (AVM) ruptureAngioma ruptureNeoplasmic bleeding (friable new vessels)Cortical thrombosisA gallery of aneurysmsSaccular (Berry) AneurysmsMost common form of cerebral aneurysm (>90%)Acquired, predisposing factors of family hx, connective tissue disorders, hypertension.Dissecting (Traumatic) AneurysmsAccount for