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Cerebral Aneurysm, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Abnormal, localized dilation or outpouching of cerebral artery wall:

    • Occurs in 5–10% of population

  • Rupture of saccular aneurysms account for 5–15% of strokes

  • Of those that rupture:

    • 40% o...

Diagnosis

Signs and Symptoms

  • Commonly asymptomatic before rupture

  • Sentinel headaches occur in 30–60% of patients before rupture:

    • Can be unilateral

  • Seizures, syncope, or altered level of consciousness

History

Treatment

Pre-Hospital

  • Cautions:

    • Neurologic examination in the field can be extremely helpful

    • Assess:

      • Level of consciousness

      • Glasgow coma scale score

      • Gross motor deficits

      • Speech abnormalities

      • Gait disturbance

      • ...

Follow-Up

Disposition

Admission Criteria

  • Any patient with acute aneurysmal subarachnoid hemorrhage should be admitted, preferably to ICU

  • Any patient with symptomatic unruptured aneurysm should receive ad...

Pearls and Pitfalls

  • CT scan alone is not sufficient to exclude subarachnoid hemorrhage

  • Vasospasm is typically seen on day 3 after bleed or surgery

  • Nimodipine can prevent or treat vasospasm but should ne...

Additional Reading

  • Backes  D, Rinkel  GJ, Kemperman  H, et al. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage. Stroke. &#...

Codes

ICD9

  • 430 Subarachnoid hemorrhage

  • 437.3 Cerebral aneurysm, nonruptured

  • 747.81 Anomalies of cerebrovascular system

ICD10

  • I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery

  • I...

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