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graphic appearance of vasospasm, but the clinical manifestations of ischemia depend on additional factors such as collateral blood supply and the cerebral perfusion pressure Hydrocephalus If a large amount of blood ruptures into the ventricular system or oods the basal subarachnoid space, it may nd its way into the ventricles through the foramina of Luschka and Magendie The patient then may become confused or unconscious as a result of acute hydrocephalus The clinical signs are greatly improved by draining the ventricles, either by external ventriculostomy or, in selected cases, by lumbar puncture A subacute hydrocephalus due to blockage of the CSF pathways by blood may appear after 2 to 4 weeks Anatomic-Clinical Correlations of Aneurysms In most patients the neurologic manifestations do not point to the exact site of the aneurysm, but it can often be inferred from the location of the main clot on CT scan.

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TABLE 3-7

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It s best to be consistent in defining user logon names we ll use the first initial and the surname (jsmith). In a multiple-domain network, you could then choose a domain suffix from the drop-down listbox, but in our testbed environment we have only @mtit.com. Jane s full user logon name is thus jsmith@mtit.com, and she can logon to the network using this name. When you specify the user logon name, it is automatically used as the pre Windows 2000 user logon name (actually only the first 20 characters are used). Click Next and specify a password for the user and any password options you wish to select. Click Next and you ll see the user s default Exchange settings (Figure 3.3). If you don t see this screen, see the following Tip. By default, the

A collection of blood in the anterior interhemispheric ssure indicates rupture of an anterior communicating artery aneurysm; in the sylvian ssure, a middle cerebral artery aneurysm; in the anterior perimesencephalic cistern, a posterior communicating or distal basilar artery aneurysm; and so on.

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Figure 4-1

In some instances clinical signs provide clues to its localization, as follows: (1) third nerve palsy (ptosis, diplopia, dilatation of pupil, and divergent strabismus), as stated above, usually indicates an aneurysm at the junction of the posterior communicating artery and the internal carotid artery the third nerve passes immediately lateral to this point; (2) transient paresis of one or both of the lower limbs at the onset of the hemorrhage suggests an anterior communicating aneurysm that has interfered with the circulation in the anterior cerebral arteries; (3) hemiparesis or aphasia points to an aneurysm at the rst major bifurcation of the middle cerebral artery; (4) unilateral blindness indicates an aneurysm lying anteromedially in the circle of Willis (at the origin of the ophthalmic artery or at the bifurcation of the internal carotid artery); (5) a state of retained consciousness with akinetic mutism or abulia (sometimes associated with paraparesis) favors a location on the anterior communicating artery, with ischemia of or hemorrhage into one or both of the frontal lobes or hypothalamus (with or without acute hydrocephalus); (6) the side on which the aneurysm lies may be indicated by a unilateral preponderance of headache or preretinal hemorrhage, the occurrence of monocular pain, or, rarely, lateralization of an intracranial sound heard at the time of rupture of the aneurysm.

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