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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
Line 20: Line 20:
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A 64 year old man presents to the emergency department for acute onset headache, with severe nausea and vomiting. The patient reports that the pain woke him up from sleep and that he had vomited four times since the pain started. Shortly after arrival, the patient loses consciousness and attempts at arousal are unsuccessful. An emergent brain CT scan is shown below. Which of the following is the most important risk factor for this patient's condition?
|Prompt=A 64-year-old male presents to the ER with an acute onset headache, severe nausea, and vomiting. The patient reports that the pain woke him up and he vomited four times as a result of the pain. Shortly after arrival, the patient loses consciousness and attempts at arousal are unsuccessful. An emergent brain CT scan is illustrated below. Which of the following is the most important risk factor for this patient's condition?


[[Image:WBR0343.jpg|500px]]<br>
[[Image:WBR0343.jpg|500px]]<br>
Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/basal-ganglia-haemorrhage-ct here]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]
Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/basal-ganglia-haemorrhage-ct here]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]
|Explanation=Charcot-Bouchard microaneurysms are small dilatations in the brain vasculature characteristically located in vessels less than 300 mcm in diameter. These aneurysms are usually located in the deep brain structures in the particularly the basal ganglia, thalamus, and internal capsule. Charcot–Bouchard are stongly linked to chronic uncontrolled hypertension, and are a common cause of hemorrhagic strokes. The most common location is the putamen. Typical features include focal neurologic signs, headache, nausea, and altered levels of consciousness. Depending on extent of the bleed, CT scan usually shows a localized area of hyperdensity (appear bright) in the brain parenchyma typically resembling the image shown above.
|Explanation=[[Charcot-Bouchard aneurysms]], small dilatations in the brain vasculature, are characteristically located in vessels less than 300 mcm in diameter. These aneurysms are usually located in the deep brain structures in the particularly the basal ganglia, thalamus, and internal capsule. [[Charcot-Bouchard aneurysms]] are linked to chronic uncontrolled hypertension, and are a common cause of hemorrhagic strokes, frequently originating in the basal ganglia, thalamus, pons, or subcortical white matter. Typical manifestations include focal neurological signs, headache, nausea, and altered levels of consciousness. Depending on extent of the [[hemorrhage]], CT scans usually display a localized area of hyperdensity (which appear bright) in the brain parenchyma, typically resembling the image above.
 
|EducationalObjectives= [[Charcot-Bouchard aneurysms]], a major cause of hemorrhagic stroke, are associated with chronic hypertension.
 
|References= Strandgaard S, Paulson OB. Cerebrovascular consequences of hypertension. Lancet. 1994;344(8921):519-21.
Educational objective: Charcot-Bouchard aneurysms are a major cause of hemorrhagic stroke associated with chronic hypertension.
 
 
Reference:<br>
Strandgaard S, Paulson OB. Cerebrovascular consequences of hypertension. Lancet. 1994;344(8921):519-21.
|AnswerA=Smoking
|AnswerA=Smoking
|AnswerAExp=Smoking is not associated with increased risk of Charcot-Bouchard microaneurysms. It increases the risk of ischemic strokes
|AnswerAExp=Smoking is not associated with an increased risk of [[Charcot-Bouchard aneurysms]], but may increase the risk of ischemic strokes.
|AnswerB=Hypertension
|AnswerB=Hypertension
|AnswerBExp=Hypertension is the major risk factor for Charcot-Bouchard microaneurysms and intraparenchymal bleeds with 90% of patients presenting with high blood pressure.
|AnswerBExp=Hypertension is the major risk factor for [[Charcot-Bouchard aneurysms]] and intraparenchymal bleeds, with 90% of patients presenting with high blood pressure.
 
|AnswerC=Diabetes mellitus
|AnswerC=Diabetes mellitus
|AnswerCExp=Diabetes mellitus is not associated with increased risk of Charcot-Bouchard microaneurysms. It increases the risk of ischemic strokes.
|AnswerCExp=Diabetes mellitus is not associated with an increased risk of [[Charcot-Bouchard aneurysms]], but may increase the risk of ischemic strokes.
|AnswerD=Marfan syndrome
|AnswerD=Marfan syndrome
|AnswerDExp=Marfan syndrome is associated with increased risk of berry aneurysms and subarachnoid hemorrhage not Charcot-Bouchard microaneurysms and intraparenchymal bleeds.
|AnswerDExp=Marfan syndrome is associated with an increased risk of berry aneurysms and subarachnoid hemorrhage, but not [[Charcot-Bouchard aneurysms]] nor intraparenchymal bleeds.
|AnswerE=Hypercholesterolemia
|AnswerE=Hypercholesterolemia
|AnswerEExp=Hypercholesterolemia is not associated with increased risk of Charcot-Bouchard microaneurysms. It increases the risk of ischemic strokes.
|AnswerEExp=Hypercholesterolemia is not associated with an increased risk of [[Charcot-Bouchard aneurysms]], but may increase the risk of ischemic strokes..
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=Charcot bouchard microaneurysms, Hypertension,
|WBRKeyword=Charcot-Bouchard aneurysms, Hypertension, aneurysm, brain, hemorrhagic stroke, chronic
|Approved=No
|Approved=Yes
}}
}}

Revision as of 15:04, 15 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathophysiology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 64-year-old male presents to the ER with an acute onset headache, severe nausea, and vomiting. The patient reports that the pain woke him up and he vomited four times as a result of the pain. Shortly after arrival, the patient loses consciousness and attempts at arousal are unsuccessful. An emergent brain CT scan is illustrated below. Which of the following is the most important risk factor for this patient's condition?


Image courtesy of Dr Frank Gaillard. Radiopaedia (original file here). Creative Commons BY-SA-NC]]

Answer A AnswerA::Smoking
Answer A Explanation [[AnswerAExp::Smoking is not associated with an increased risk of Charcot-Bouchard aneurysms, but may increase the risk of ischemic strokes.]]
Answer B AnswerB::Hypertension
Answer B Explanation [[AnswerBExp::Hypertension is the major risk factor for Charcot-Bouchard aneurysms and intraparenchymal bleeds, with 90% of patients presenting with high blood pressure.]]
Answer C AnswerC::Diabetes mellitus
Answer C Explanation [[AnswerCExp::Diabetes mellitus is not associated with an increased risk of Charcot-Bouchard aneurysms, but may increase the risk of ischemic strokes.]]
Answer D AnswerD::Marfan syndrome
Answer D Explanation [[AnswerDExp::Marfan syndrome is associated with an increased risk of berry aneurysms and subarachnoid hemorrhage, but not Charcot-Bouchard aneurysms nor intraparenchymal bleeds.]]
Answer E AnswerE::Hypercholesterolemia
Answer E Explanation [[AnswerEExp::Hypercholesterolemia is not associated with an increased risk of Charcot-Bouchard aneurysms, but may increase the risk of ischemic strokes..]]
Right Answer RightAnswer::B
Explanation [[Explanation::Charcot-Bouchard aneurysms, small dilatations in the brain vasculature, are characteristically located in vessels less than 300 mcm in diameter. These aneurysms are usually located in the deep brain structures in the particularly the basal ganglia, thalamus, and internal capsule. Charcot-Bouchard aneurysms are linked to chronic uncontrolled hypertension, and are a common cause of hemorrhagic strokes, frequently originating in the basal ganglia, thalamus, pons, or subcortical white matter. Typical manifestations include focal neurological signs, headache, nausea, and altered levels of consciousness. Depending on extent of the hemorrhage, CT scans usually display a localized area of hyperdensity (which appear bright) in the brain parenchyma, typically resembling the image above.

Educational Objective: Charcot-Bouchard aneurysms, a major cause of hemorrhagic stroke, are associated with chronic hypertension.
References: Strandgaard S, Paulson OB. Cerebrovascular consequences of hypertension. Lancet. 1994;344(8921):519-21.]]

Approved Approved::Yes
Keyword WBRKeyword::Charcot-Bouchard aneurysms, WBRKeyword::Hypertension, WBRKeyword::aneurysm, WBRKeyword::brain, WBRKeyword::hemorrhagic stroke, WBRKeyword::chronic
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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