Question

Donna is a 43-year-old teacher who was admitted 6 days ago with a ruptured middle cerebral artery (MCA) aneurysm with subarachnoid hemorrhage (SAH). She underwent surgery for aneurysm clipping 12 hours after admission, and has had an excellent post-operative course. However, this morning, she complained of a severe headache, became acutely confused and quickly progressed to unresponsiveness. What is the likely cause for Donna's change of status? a. Expansion of her original SAH b. Uncal herniation c. Cerebral vasospasm d. Medication reaction

Answer 1

Donna's symptoms of severe headache, acute confusion, and unresponsiveness are most likely due to cerebral vasospasm, a common complication following subarachnoid hemorrhage from a ruptured aneurysm.

Step-by-step explanation:

The likely cause for Donna's change of status, presenting with a severe headache, acute confusion, and progression to unresponsiveness after undergoing aneurysm clipping for a ruptured middle cerebral artery aneurysm with subarachnoid hemorrhage, is cerebral vasospasm. Cerebral vasospasm refers to the narrowing of cerebral blood vessels, which can occur as a complication of subarachnoid hemorrhage. This vasospasm can lead to decreased blood flow to areas of the brain, potentially causing ischemia and neurological deficits.

An expansion of the original SAH or a medication reaction are also potential causes but are less likely given the post-operative course and timeframe. An uncal herniation would typically present with different neurological signs such as pupil dilation and changes in level of consciousness related to increased intracranial pressure on one side of the brain, and not solely confusion and headache.

Answer 2

The likely cause for Donna's change of status is uncal herniation, which occurs when the brain tissue is pushed from one compartment of the brain to another due to increased pressure.

Step-by-step explanation:

The likely cause for Donna's change of status is uncal herniation (b).

Uncal herniation occurs when the brain tissue is pushed from one compartment of the brain to another due to increased pressure. In this case, the severe headache and rapid progression to unresponsiveness suggest that swelling or bleeding in the brain may be causing the herniation.

Cerebral vasospasm (c) is a potential complication after SAH, but it usually occurs a few days after the initial hemorrhage. Expansion of the original SAH (a) is less likely since Donna had an excellent post-operative course and 6 days have passed since her admission. Medication reaction (d) is also unlikely to cause such a rapid change in status.