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Now Lets Goto the Question
The patient, a 55-year-old male, presents with a sudden onset of severe headache, described as the worst headache of his life, and photophobia.
On examination, his blood pressure is noted to be 160/110 mm Hg.
A CT scan of the head reveals subarachnoid hemorrhage (SAH). Considering these findings, what is the next step in managing this patient?
A. Nimodipine
B. Conventional angiography for aneurysm
C. Urgent surgical intervention
D. IV Mannitol
Correct Answer - B
Explanation
In the case of subarachnoid hemorrhage SAH, identifying the source of the hemorrhage is crucial. This is typically done using angiography, which provides visualization of the blood vessels in the brain. The most common cause of SAH is a ruptured aneurysm. Angiography will help identify the exact location, size, and shape of the aneurysm, which is necessary information for planning definitive treatment, such as surgical clipping or endovascular coiling.
Given this context, option B does make sense as the next step in management, especially if there's a high index of suspicion for an aneurysmal source of the SAH.
Rationale for each option:
A. Nimodipine - This is given to prevent vasospasm, which can occur days after the initial bleed. While it is essential in the management of SAH, identifying and securing the source of the hemorrhage might take precedence.
B. Conventional angiography for aneurysm - As stated above, identifying the source of the bleed is vital, especially if the clinical suspicion for an aneurysmal source is high. Once identified, definitive treatments like surgical clipping or endovascular coiling can be planned.
C. Urgent surgical intervention - This is not typically the immediate step without having clear knowledge of the source of the bleed.
D. IV Mannitol - Used for elevated intracranial pressure. Not typically the immediate step unless there are signs of increased ICP.
In the context of needing to identify the cause of the SAH, B. Conventional angiography for aneurysm is indeed a logical next step.