Cerebral Aneurysm: Treatment

by Carlo Raj, MD

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    00:01 Management.

    00:03 Clip or coil once you identify the aneurysm.

    00:07 Hydrocephalus is a possibility.

    00:09 And by this, you’re going to then drain out the fluid, intraventricular catheter.

    00:13 However, as soon as that happens, you’re always worried about what, please? Infections.

    00:18 Vasospasms, you want to treat that.

    00:20 Highest rate within 21 days.

    00:23 Treat with nimodipine, calcium-channel blocker.

    00:29 Always look for or try to manage your hypertension, maybe hypervolemia, hemodilution.

    00:35 And here once again, you want to try to control things and manage.

    00:40 And so therefore intraventricular catheter.

    00:42 Oftentimes, you’ll find the vasospasms within three weeks.

    00:47 Continuing our discussion of subarachnoid hemorrhage.

    00:52 Let’s officially enter the topic itself.

    00:57 We just came off our discussion of aneurysms.

    01:00 And if that aneurysm is to then get large enough, it ruptures.

    01:03 And in this case, with the berry aneurysm that we referred to, you are then going to bleed into your subarachnoid space and perhaps even then bleed onto your intraparenchymal type of hemorrhage.

    01:16 The complications here as you know would be the worst headache that he or she has experienced called “thunderclap headache.” Meningismus type of symptoms, and altered mental status.

    01:26 On CT, you can then expect to see the intraparenchymal type of hemorrhage that you see here.

    01:33 The complications that you’re worried about as we had mentioned earlier, if you peak approximately three weeks or 21 days into your subarachnoid hemorrhage, you want to try to manage your vasospasms.

    01:44 And there, we refer to our calcium channel blocker, nimodipine, or you are now also having issues with properly draining your cerebrospinal fluid, resulting in hydrocephalus and that increase intracranial pressure could be then managed with drainage, maybe perhaps with intraventricular type of catheter.

    02:07 Summary.

    02:08 Risk factors: age, female, gender, African-American race most likely due to hypertension, smoking, stimulants, alcohol.

    02:18 Preventive medicine.

    02:20 Remember, if your patient you know is predisposed to developing an aneurysm, usually about let’s say fifth decade of life.

    02:29 Management of unruptured aneurysm, 1% of the general population.

    02:34 Annual risk of SAH is 1 to 2%, is related to aneurysm size.

    02:39 Signs and symptoms. We talked about the headache, there could be loss of consciousness, think of it as being like a space-occupying lesion.

    02:46 Differential diagnoses. At some point, we have discussed cluster headaches, migraines, meningitis, are all differential diagnoses when dealing with subarachnoid hemorrhage.

    02:59 Acute and post acute diagnostic workup.

    03:02 CT scan.

    03:03 We did a lumbar puncture and we discussed the tubes that you would find.

    03:08 For example, because you’re continuously introducing blood into the subarachnoid space no matter how many samples you take for RBC count, It will always be pretty much elevated between one and four.

    03:23 Angiogram, you’d want to check out what caused the subarachnoid hemorrhage and transcranial Dopplers as well could help you.

    03:29 In other words, ultrasound.

    03:32 The management here will be clipping.

    03:34 We talked about coiling of the aneurysm.

    03:36 Treatment of the vasospasms that we talked, nimodipine, and we have our therapy of HHH, hypertension, hypervolemia, hemodilution.

    03:47 HHH therapy.

    03:49 All so that you could manage your subarachnoid hemorrhage.

    About the Lecture

    The lecture Cerebral Aneurysm: Treatment by Carlo Raj, MD is from the course Cerebral Aneurysm (Intracranial Aneurysm). It contains the following chapters:

    • Cerebral Aneurysms: Treatment
    • Subarachnoid Hemorrhage
    • Subarachnoid Hemorrhage: Summary

    Included Quiz Questions

    1. Coiling of an aneurysm
    2. Hypertension management
    3. Hypervolemia management
    4. Hemodilution management
    5. Using a Calcium Channel blocker
    1. Thunder clap headache
    2. Cluster headache
    3. Tension headache
    4. Migraine headache
    5. Sinus headache
    1. Dementia
    2. Vomiting
    3. Loss of consciousness
    4. Nausea
    5. Severe headache

    Author of lecture Cerebral Aneurysm: Treatment

     Carlo Raj, MD

    Carlo Raj, MD

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