Cerebral aneurysm: The Daily PANCE Blueprint
A 48-year-old female with a history of frequent UTIs is brought to the ER complaining of a sudden, thunderclap headache that is “the worst in her life.” She is hypertensive (SBP 150s). On exam her neck is stiff. Which of the following conditions is the most likely predisposing factor causing her symptoms?
A. Bacterial infection
B. Viral infection
C. Hypercoaguable disorder
D. Atherosclerosis
E. Saccular aneurysm
Answer and topic summary
The answer is E. Saccular aneurysm
Berry aneurysms are the most common type of cerebral aneurysm. Risk factors include hypertension, advanced age, hyperlipidemia, alcoholism, and congenital disorders (ADPKD, Marfan, etc). They occur usually at the Circle of Willis (between the anterior cerebral and anterior communicating artery most commonly). Patients may be asymptomatic or may have bitemporal hemianopsia and visual acuity defects. When the aneurysm ruptures, this is when it is then referred to as a hemorrhage (which the patient in the above question has). Unruptured intracranial aneurysms can be managed conservatively (e.g. lifestyle modification) or patients can undergo surgical clipping/coiling.
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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
