Neurologic System

Question 0

Subdural Hematoma

Answer 0

• Blood collection under the dura
• Etiology: tearing of bridging veins that pass through the space between the cortical surface and the dural venous sinuses or injury to the brain surface with resultant bleeding from cortical vessels
• Acute: sx in 24hrs
• Subacute: sx in 3-14 days
• Chronic: sx after 2 wks
• Tx: Craniotomy with clot evacuation
• CT findings: curved crescent shaped hematoma

Question 1

Subarachnoid Hemorrhage

Answer 1

• Blood below the arachnoid membrane and above the pia
• Etiology: Trauma is #1 cause, ruptured berry aneurysm(saccular outpouching of vessels in the circle of Willis usually at bifurcation; occurs most often at anterior communicating artery; polycystic kidney disease and connective tissue disorders such as Marfan’s syndrome increase risk of berry aneurysm), arteriovenous malformation(AVM; congenital abnormality of the vasculature with connections b/t arterial and venous circulations without interposed capillary network).
• Sx: “worst HA of my life”, neck pain, positive Kernig’s and Brudzinski’s signs, LOC, N/V, photophobia
• Workup: Head CT, LP, arteriogram to look for aneurysms or AVMs
• Complications: brain edema–> increased ICP, rebleeding, vasospasm
• Tx vasospasm: Nimodipine
• Tx aneurysms: surgical: place metal clip on the aneurysm or balloon occlusion or coil embolization.
• Tx AVMs: surgical, pre-op embolization, if surgically inaccessible radiosurgery.

Question 2

Epidural Hematoma

Answer 2

• Collection of blood between the skull and dura
• Etiology: association with skull fx as bone fragments lacerate meningeal arteries
• Associated with middle meningeal artery
• Classic hx: LOC followed by lucid interval followed by neurologic deterioration
• CT findings: lens shaped hematoma
• Surgery: surgical evacuation. Indicated in any symptomatic pt or any hematoma >1cm.