Cerebral aneurysm: The Daily PANCE Blueprint
A 45-year-old woman presents to the emergency department with a sudden, severe headache described as "the worst headache of my life." She also reports nausea, vomiting, and photophobia. A CT scan shows subarachnoid hemorrhage. What is the most appropriate next step in the management of this patient?
A. Lumbar puncture
B. Cerebral angiography
C. High-dose corticosteroids
D. Antiepileptic medication
E. MRI of the brain
Answer and topic summary
The answer is B. Cerebral angiography.
The patient’s symptoms and CT findings are highly suggestive of a ruptured cerebral aneurysm causing subarachnoid hemorrhage. Cerebral angiography is the gold standard for diagnosing and localizing cerebral aneurysms and is crucial for planning surgical or endovascular intervention.
Incorrect Answers:
- A. Lumbar puncture: While a lumbar puncture can help diagnose subarachnoid hemorrhage if the CT scan is negative, it is contraindicated when there is evidence of increased intracranial pressure or a mass lesion, as it may lead to brain herniation.
- C. High-dose corticosteroids: Corticosteroids are not indicated in the treatment of cerebral aneurysms or subarachnoid hemorrhage.
- D. Antiepileptic medication: While seizures can occur following subarachnoid hemorrhage, antiepileptic medication is not the immediate priority in management.
- E. MRI of the brain: While MRI can provide detailed images, it is not the diagnostic modality of choice for a suspected ruptured cerebral aneurysm.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
Also covered as part of the Internal Medicine EOR topic list
