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NS by Dorka > Ch. 5 - Traumatic intracranial hematomas > Flashcards

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
Q

How often are subdural hematomas bilateral in infants?

A

85% of cases

26
Q

Earliest finding of chronic subdural hematoma in infants

A

Excessive cranial enlargement; nonspecific findings (failure to thrive, irritability)

27
Q

Tx of chronic subdural hematoma in infant

A

Aspirate fluid; shunt if repeated aspirations unsuccessful

28
Q

Causes of intracerebral hematoma

A

Penetrating injury, depressed skull fracture, severe head trauma

29
Q

What other type of hemorrhage is commonly associated with subdural hematoma?

A

Intracerebral hemorrhage

30
Q

CT findings of intracerebral hematoma

A

Multiple hematomas in contre-coup distribution

31
Q

Why repeat CT in patient with a head injury but previously negative scan?

A

Intracerebral hematomas frequently evolve more than 24 hrs after trauma

32
Q

Tx of large intracerebral hematoma? Small?

A

Large - evacuation unless neurological state is improving; small - observation

33
Q

Identify the lesion

A

Extradural hematoma

34
Q

Identify the lesion

A

Chronic subdural hematoma

35
Q

Identify the lesion

A

Acute subdural hematoma

36
Q

Define 3 types of subdural hematomas

A

Acute - less than 3 days

Subacute - 4-21 days

Chronic - 21+ days

NS by Dorka (21 decks)

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