Which of the following is the most common cause of late neurological deterioration in a case of cerebrovascular accident: (AIIMS Nov 2012)
Delayed neurologic deficits –
1). Re rupture – At 7 - 14 days
2). Hydrocephalus – Acute → causes stupor, coma.
3). Subacute → slowed mentation with urinary in continence
4). Chronic → Gait difficulty, incontinence
5). Vasospasm – Most frequently at 3 - 7 days.
6). Hyponatremia – Due to SIADH, first 2 weeks.
Most common cause of late CNS deterioration in SAH is hydrocephalus. (AIIMS May 2011)
Extra Edge: Hydrocephalus.
1. Acute hydrocephalus can cause stupor and coma and can be mitigated by placement of an external ventricular drain.
2). Subacute hydrocephalus may develop over a few days or weeks and causes progressive drowsiness or slowed mentation (abulia) with incontinence. Hydrocephalus may clear spontaneously or require temporary ventricular drainage.
3). Chronic hydrocephalus may develop weeks to months after SAH and manifest as gait difficulty, incontinence, or impaired mentation. Subtle signs may be a lack of initiative in conversation or a failure to recover independence.
4). Diagnosis: CT Scan
5). Treatment: An aneurysm can be clipped by a neurosurgeon or coiled by an endovascular surgeon.