Ch. 5 - Traumatic intracranial hematomas Flashcards

1
Q

Most common site of extradural hematoma?

A

Temporal region > frontal; uncommonly posterior fossa and parasagittal

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2
Q

Vessel most likely torn in extradural hematoma

A

Middle meningeal artery

Uncommonly extradural veins, superior sagittal sinus, transverse sinus, posterior meningeal

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3
Q

How often does a fracture overly an extradural hematoma?

A

95% of adults; 75% of children

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4
Q

Population most likely to have extradural hematoma

A

Children and adults <20 years because dura strips off more readily

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5
Q

Extradural hematoma presentation

A

Severe head injury followed by deterioration of neurological state (esp. CN3 palsy and hemiparesis), HA, possibly transient LOC, Cushing’s reflex

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6
Q

Most important neurological sign of extradural hematoma

A

Deteriorating conscious state after lucid interval

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7
Q

CT appearance of extradural hematoma

A

Hyperdense biconvex hematoma with compression of underlying brain and distortion of lateral ventricle

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8
Q

Tx of extradural hematoma

A

Craniotomy and evacuation, mannitol or furosemide infusion, hyperventilation

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9
Q

Burr hole locations for extradural hematoma tx

A

Temporal first, then frontal and parietal

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10
Q

If extradural hematoma location is unknown, which side do you burr hole

A

Side of fracture

Underlying boggy swelling of skull

Same side as dilated pupil if present

85% of cases on contralateral side of hemiparesis

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11
Q

Why open dura during extradural hematoma evacuation?

A

To exclude coexisting subdural hematoma

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12
Q

Prognosis of extradural hematoma

A

Potentially reversible, full recovery expected if evacuated early enough

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13
Q

Causes of acute subdural hematoma

A

Severe trauma and cortical lacerations OR

Less severe trauma and rupture of bridging veins (esp. if anticoagulated or cortical atrophy)

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14
Q

Appearance of subdural hematoma on CT

A

Concave towards brain:

Acute - hyperdense

Subacute - isodense with adjacent brain

Chronic- hypodense

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15
Q

How often are acute subdural hematomas bilateral?

A

1/3 of cases

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16
Q

Presentation of acute subdural hematoma

A

Severe head injury with deteriorating neuro state or failure to improve

17
Q

Commonly associated fracture with acute subdural hematoma

A

80% have fracture of cranial vault or base of skull

18
Q

Treatment of acute subdural hematoma

A

Craniotomy to evacuate

19
Q

Two major groups of chronic subdural hematomas

A

Severe head injury OR

No history of head trauma (1/3 of cases) - 2/2 rupture of bridging veins in cortical atrophy

20
Q

Presentation of chronic subdural hematoma

A
  1. Deterioration after head injury
  2. Increased ICP without localizing signs
  3. Fluctuating drowsiness
  4. Progressive dementia (more rapid than Alzheimer’s) with possible focal neurological signs esp. hemiparesis
21
Q

How often are chronic subdural hematomas bilateral?

A

25% of cases

22
Q

Tx of chronic subdural hematomas

A

Burr holes vs. craniotomy but do not attempt to excise hematoma membrane (may be multiloculated)

23
Q

Post-op management of chronic subdural hematoma evacuation

A

Lie patient flat + adequate hydration to encourage brain to swell and expand into hematoma space (watch for hyponatremia)

24
Q

Causes of chronic subdural hematoma in infancy

A

Birth trauma, abuse (10% of battered children)

25
How often are subdural hematomas bilateral in infants?
85% of cases
26
Earliest finding of chronic subdural hematoma in infants
Excessive cranial enlargement; nonspecific findings (failure to thrive, irritability)
27
Tx of chronic subdural hematoma in infant
Aspirate fluid; shunt if repeated aspirations unsuccessful
28
Causes of intracerebral hematoma
Penetrating injury, depressed skull fracture, severe head trauma
29
What other type of hemorrhage is commonly associated with subdural hematoma?
Intracerebral hemorrhage
30
CT findings of intracerebral hematoma
Multiple hematomas in contre-coup distribution
31
Why repeat CT in patient with a head injury but previously negative scan?
Intracerebral hematomas frequently evolve more than 24 hrs after trauma
32
Tx of large intracerebral hematoma? Small?
Large - evacuation unless neurological state is improving; small - observation
33
Identify the lesion
Extradural hematoma
34
Identify the lesion
Chronic subdural hematoma
35
Identify the lesion
Acute subdural hematoma
36
Define 3 types of subdural hematomas
Acute - less than 3 days Subacute - 4-21 days Chronic - 21+ days