Most common nerve involved in intracranial aneurysm is : (DNB Dec 2010)
1). C.T head (Best to diagnosis). Non contrast CT scan: Investigation of choice (LP is not indicated prior to an imaging procedure). Blood is seen in the sylvian fissure.
2). CSF examination:
a. Hallmark is blood in CSF
b. Xanthochromic CSF – lysis of RBCS and Subsequent conversion of Hb to bilirubin stains the spinal fluid yellow within 6 – 12 hours. Peak 48 hours & lasts for 1 – 4 weeks.
3). MR angiography – For unruptured aneurysm.
1). Medical support
a. Airway protection
b. BP management
c. Prevent vasospasm – Nimodipine, volume expansion.
2). Triple H method of Rx → Hypertension, hemodilution & hypervolemia (Ref. Hari-18th ed., pg- 2264)
3). If vasospasm persists
a. Intracranial papaverine
b. Phenytoin given as prophylactic therapy
c. Surgery – Clipping of aneurysm
4). Recent Advances = Endovascular coiling