Welcome to the TBI-HELP Live Chat

Today's topic is: "The relationship between size of cerebral aneurysm and outcome in patients with subarachnoid hemorrhages"

Our Guests are: Dr. Yieing Acefe, Resident Jamaica Hospital Medical Center, TBI Unit and  
Dr. Syed Rahman, House Staff Physician at Jamaica Hospital 

Topic Summary:

-Between 5-10% of strokes are due to subarachnoid hemorrhages.

-Usually subarachnoid hemorrhage from rupture of aneurysms or arteriovenous malformation, but about 20 % of cases will not have any specific causes.

-CT angiography provides more accurate data on aneurysm size as well as the ability to study the relation between the size and outcome.

[19:10:57] mod: Good Evening and welcome to our chat session this evening. It is our pleasure to have with us this evening Dr. J. Acefe, Resident Neurosurgery and Dr. S. Rahman, House Staff Doctor of the Traumatic Brain Injury Unit. Both are from Jamaica Hospital Medical Center. Welcome!
[19:12:36] Dr.J.Acefe/Dr.S.Rahman: Good Evening. It is our pleasure to be here with you.
[19:15:10] Dr.J.Acefe/Dr.S.Rahman: Subarachnoid hemorrhage is the extravasation of blood in the subarachnoid space of the brain. It is the accumulation of blood in the subarachnoid space of the brain commonly caused from rupture of brain aneurysm.
[19:17:30] mod: Is there a common age for this to occur?
[19:18:10] Dr.J.Acefe/Dr.S.Rahman: It is usually common in the middle aged population.
[19:18:47] mod: Why doe this occur in middle age people?
[19:20:33] Dr.J.Acefe/Dr.S.Rahman: there is no scientific explanation for the reason why it happens more commonly in middle aged group.
[19:21:20] mod: Gruyere: What type of deficits are you likely to see after a subarachnoid hemorrhage and what is the prognosis?
[19:23:34] Dr.J.Acefe/Dr.S.Rahman: The worst headaches of life is the typical presentation followed by changes in the mental status are the common presentations. In addition there could be motor or cranial nerve dysfunctions.
[19:25:05] mod: Rail: Give the vasculature that is involved and the location - is there any "screening" that can alert the 40+ population other than a CT angiogram?
[19:25:57] Dr.J.Acefe/Dr.S.Rahman: Yes. A digital subtraction angiogram can be used as a reliable diagnostic mean in this case.
[19:26:37] mod: what are some of the signs and symptoms of a subarachnoid hemorrhage?
[19:29:16] Dr.J.Acefe/Dr.S.Rahman: Worst headaches of life is the most important and most common presentation for these patients. In addition patients with subarachnoid hemorrhage can have signs and symptoms of meningismus e.g. stiffness of the neck , vomiting and change of mental status.
[19:30:06] Dr.J.Acefe/Dr.S.Rahman: Also patients can have neurological defeciencies from nerve dysfunctions.
[19:30:26] mod: Susan: Are there warnings we can be alerted to?
[19:32:34] Dr.J.Acefe/Dr.S.Rahman: Headaches which is not a regular type of headache one usually gets that means if somebody has headaches which he or she never experienced before in his or her life should be the most important warning features one should look for.
[19:33:20] mod: Rail: Isn't a CT Angio a bit expensive for screening or is there a High Rick profile to reduce the candidate population?
[19:34:34] Dr.J.Acefe/Dr.S.Rahman: No it is not that expensive comparing with other existing neurological testing but it does need to be done by a very skilled technologist.
[19:35:46] mod: Susan: Do they always burst or can they be shrunk or removed?
[19:38:54] Dr.J.Acefe/Dr.S.Rahman: Actually when the neurosurgeons see the patients the aneurysms are usually burst but if by other means e. g. MRI of the head for any other reason reveal as an incidental finding then it can be operated even before it bursts.
[19:39:21] mod: What about Risk Factors - is there a check-list to help adjust lifestyle to avoid this type of stroke?
[19:41:47] Dr.J.Acefe/Dr.S.Rahman: Hypertension , stress ,smoking, drug abuse are the important risk factors which needs to be controlled in order to prevent this type of injury.
[19:43:01] mod: How does Cerebral Aneurysm produce subarachnoid hemorrhage?
[19:44:58] Dr.J.Acefe/Dr.S.Rahman: As the vasculature which burst usually runs through the subarachnoid space of the brain and so the blood typically accumulates in the subarachnoid region of the brain.
[19:45:19] mod: How can blood pressure affect the presentation of this problem?
[19:46:50] Dr.J.Acefe/Dr.S.Rahman: Increase in the blood pressure in the area of the aneurysm is an important risk factor in order to get the specific vessel site (aneurysm) to get ruptured. As the wall of the aneurysm is very thin it is very easily ruptured from an increase in the pressure against the wall.
[19:48:36] mod: Rail: Will the subarachnoid hemorrhage represent some significant threat to brain tissue, or simply elevate the ICP to cause secondary damage to the cortex?
[19:50:26] Dr.J.Acefe/Dr.S.Rahman: Yes it does. Because the hemorrhage may extend to the brain parenchymal tissue adding tissue damage. And with concomitant elevated ICP it actually damages the brain tissue even more.
[19:50:45] mod: Boopski831: After rehabilitation from 4 aneurysms is there a possibility of resuming a normal life?
[19:52:17] Dr.J.Acefe/Dr.S.Rahman: In our experience we haven't seen that. We so far have seen patients living almost normal life after getting treated for two aneurysms.
[19:52:51] mod: Susan: Is the area injured usually local to the rupture or more widespread?
[19:53:44] Dr.J.Acefe/Dr.S.Rahman: It could be both ways depending on the location of the aneurysm.
[19:54:28] mod: After the Patient is medically stable what is the next step in the TBI rehabilitation?
[19:57:00] Dr.J.Acefe/Dr.S.Rahman: Actually it depends on the neurological deficit one has from the aneurysm burst. Patient can get TBI rehab benefit if he or she does have some neurological deficit e.g cognitive , speech / motor deficiencies , they can be benefited from TBI acute rehabilitation.
[20:00:08] mod: I see that our time is just about up for this evening. I would like to extend my thanks to both Dr Acefe and Dr. Rahman for a wonderful session and I invite then to return in the future for another session. Thank you all for coming and have a wonderful and safe week.
[20:02:08] Dr.J.Acefe/Dr.S.Rahman: It was indeed a great pleasure for both of us to be with you. Thank you and Good night.