NBME Step 2 CK Form 8 Hypertension (NBME Answers)

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submitted by ∗step_prep3(25)

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Patient with Cushing’s triad (bradycardia, hypertension and irregular respirations) which is a sign of elevated intracranial pressure with a CT scan showing a high-density peri-ventricular hemorrhage, most consistent with a hypertensive bleed
Key idea: Common causes of brain bleeds include trauma, hypertension and cerebral amyloid angiography

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seagull Bathrooms are very common areas of falling for the elderly/everyone. However, those tend to result in intracranial hematomas. This is a very significant brain bleed. HTN is classically associated with lacunar infarcts which honestly are not as massive as shown. THis might be a ruptured berry aneurysm from HTN but we couldn't know for sure. Not a great question but he has pre-existing HTN so I guess we'll go with it. +6

saffronshawty bruh, i straight up thought that was a tumor lol +21

lindasmith462 I still dont get how this isnt' amyloid angiopathy - its the most common cause of spontaneous parenchemal hemorrhage in pts >60 (sure this guy is only 57 but NBME loves to give just off age ranges) and is especially seen in people doing routiene activity - HTN would have to be a SUDDEN increase in blood pressure - which he doesnt have a history suspicious for..... like if they said he was running or something sure +2

aoluwatayo according to FA step 1, Intraparenchymal haemorrhage is most commonly caused by HYPERTENSION( charcot-bouchard microaneurysm).occuring in basal ganglia > thalamus > Pons > Cerebellum. Other causes are; Amyloid angiopathy in elderly, vasculitis and neoplasm +

osler_weber_rendu Amyloid angiopathy is commonly restricted to one lobe acc to UW +

merpaperple I thought this was a tumor too. Brain tumors look more like discrete solid masses (eg https://radiologyassistant.nl/img/containers/main/brain-tumor-systematic-approach/a5097978407bd7_calcification-2.jpg/0f040f73ea87585a751f39222d4a0b1c.jpg). Intracranial hemorrhage is more diffuse and "fluffy" (eg https://media.sciencephoto.com/image/c0271775/800wm) +1

adong lol i feel like that second pic has more well defined borders. tbh i think the best way is probably to look at the intensity of the lesion. for bleeds it's almost as white as the skull bone +1

beans123 bright white is blood on these scans +

drzed if it was a brain tumor, it would be intraventricular, which means that it would be an ependymoma. Those tumors are not only slow growing (not explaining his sudden onset of symptoms), but more common in children. You can't have a tumor the size of half your brain SUDDENLY knock you out--it would be a gradual development of symptoms. +1