American family physician
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American family physician · Oct 2023
Nontraumatic Subarachnoid Hemorrhage and Ruptured Intracranial Aneurysm: Recognition and Evaluation.
Subarachnoid hemorrhage caused by a ruptured intracranial aneurysm is a neurosurgical emergency with a mortality rate of approximately 50%. Prompt identification and treatment of aneurysmal subarachnoid hemorrhage are paramount to reduce mortality, long-term morbidity, and health care burden for survivors. The prevalence of intracranial aneurysms is 2% to 6% of the global population, many of which are found incidentally during workup for an unrelated condition. ⋯ The Ottawa Subarachnoid Hemorrhage Rule is a validated clinical decision tool to help determine which patients with a sudden, acute headache require imaging with noncontrast computed tomography. Based on the results of initial computed tomography and duration of symptoms, the patient may require a lumbar puncture or additional imaging to confirm the diagnosis. Prompt diagnosis of an aneurysmal subarachnoid hemorrhage is essential to patients receiving definitive treatment.
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Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses, with a prevalence of approximately 1% to 7%. It is defined by the presence of at least two cardinal symptoms (nasal blockage, obstruction, or congestion; anterior or posterior nasal drainage; facial pain or pressure; and hyposmia) for at least three consecutive months, with objective findings on imaging or nasal endoscopy. CRS can result in significant patient costs and lower quality of life due to severe fatigue, depression, and sometimes reduced cognitive function. ⋯ Optimal maintenance therapy can help alleviate exacerbations. Patients with refractory CRS that is not responsive to first-line treatment and patients with alarm symptoms should be referred to an otolaryngologist for further evaluation and consideration of surgical management. Identifying patients who have CRS with nasal polyps or comorbid conditions such as atopic dermatitis, asthma, or eosinophilic esophagitis is especially important to ensure they are referred to a specialist for consideration of biologic therapy.