head and neck lecture 14

Question 1

where do epidural hematomas occur

Answer 1

bleeding on top of dura (bw dura and skull)

Question 2

What is the weakest part of the skull?

Answer 2

pterion

Question 3

where is pterion bone

Answer 3

in the temporal fossa on external skull

Question 4

at the location of the pterion, but on the internal skull is where which artery travels encased in bone

Answer 4

middle meningeal artery

Question 5

what are the 2 reasons why the skull is most likely to fracture at the pterion

Answer 5

bone is thinner here (middle meningeal travels thru it) and it’s an articulation of multiple bones

Question 6

where do the middle meningeal artery come from

Answer 6

foramen spinosum

Question 7

what foramina does the middle meningeal artery travel to first to enter the skull

Answer 7

foramen spinosum

Question 8

can you see the middle meningeal artery itself in the dura

Answer 8

yes

Question 9

if there is a fracture in the pterion the middle meningeal artery could tear and bleed into the cranial cavity into the _______ causing an _________

Answer 9

epidural space
epidural hematoma

Question 10

an epidural hematoma occurs bw

Answer 10

the dura and the skull

Question 11

epidural hematoma is most likely seen in

Answer 11

kids who have a head injury with fracture of the temporal bone

Question 12

in theory, can an epidural hematoma cross the midline bc it is located bw the dura and the skull

Answer 12

yes but since dura is tightly adherent to the adjacent skull near suture lines, it doesnt usually cross suture lines

Question 13

separates right and left halves of the brain

Answer 13

falx cerebri

Question 14

if the middle artery bleeds into the epidural space (epidural hematoma) the _____________ will herniate over the tentorial margin

Answer 14

temporal lobe

Question 15

what is the most medial projection of the temporal lobe

Answer 15

uncus

Question 16

the herniating brain will towards the weakest areas (biggest openings)

Answer 16

tentorial notch
forament magnum

Question 17

the ______ is found in the core of the brainstem

Answer 17

reticular formation

Question 18

the reticular formation is responsible for

Answer 18

the awakened state = consciousness

Question 19

in an epidural hematoma, the medulla and cerebellum will move towards the weakest area

Answer 19

foramen magnum compressing the medulla with its vital centers

Question 20

where is the reticular formation found

Answer 20

in dorsal brainstem

Question 21

herniation of the temporal love (uncus) over the free edge of tentorium compresses CN 3 causing a

Answer 21

dilated pupil

Question 22

what should pupils do when you shine light into eyes

Answer 22

constrict

Question 23

what should eyes do in dim

Answer 23

dilate

Question 24

a compressive CN 3 palsy can present initially as just a

Answer 24

dilated pupil

Question 25

what fibers travel outside of CN 3

Answer 25

parasympathetic nervous fibers

Question 26

epidural hematoma affects

Answer 26

middle meningeal artery = arterial blood under high pressure

Question 27

subdural hematoma affecs

Answer 27

bridging veins = venous blood under less pressure - slower bleed than arterial blood

Question 28

patients with a subdural hematoma may not become symptomatic until

Answer 28

a few weeks after an episode of trauma

Question 29

where does a subdural hematoma take place

Answer 29

beneath the dura, bw the dura and arachnoid (in subdural space)

Question 30

in a subdural hematoma, is it venous or arterial blood

Answer 30

since arteries do not travel in the subdural space, this is not an arterial bleed it is venous blood

Question 31

does a subdural hematoma cross midline

Answer 31

it can not because the falx cerebri doesn't let it cross to the other side

Question 32

a subdural hematoma is the collection of blood between

Answer 32

the inner layer of dura and the arachnoid

Question 33

what causes a subdural hematoma

Answer 33

a rupture of the cortical bridging veins

Question 34

subdural hematomas are most common in

Answer 34

-pt treated with anticoagulants - elderly and alcoholics with atrophy

Question 35

if subdural hematomas are not treated they can damage the

Answer 35

reticular activating system

Question 36

subdural hematomas occur due to tearing of _____ that are transporting venous blood from the cortex to the DVS

Answer 36

external cortical bridging veins

Question 37

subdural hematomas occur due to

Answer 37

trauma

Question 38

external cortical (bridging) veins drain into

Answer 38

the superior saggital sinus

Question 39

internal cortical veins drain into the great vein of galen. would damage to the inernal cortical cause a subdural hematoma

Answer 39

no

Question 40

what are the signs/symptoms of a SDH

Answer 40

-severe headache -vomiting -dizziness -sudden weakness arm or leg dilated pupil RAS compromised: decreased consciousness confusion inability to wake up

Question 41

the headache associated with a SSH is due to

Answer 41

meningeal irritation innervated by CN 5

Question 42

who is most at risk for a SDH

Answer 42

people who are fragile -the elderly - infants - anyone who sustains severe head trauma

Question 43

______ is the occurrence of a vitreous hemorrhage in association with intracranial hemorrhage and elevated ICP

Answer 43

terson syndrome

Question 44

subarachnoid hemorrhage causes increased

Answer 44

intracranial pressure and papilledema

Question 45

the most common presenting problem from an aneurysm is

Answer 45

rupture with bleeding in subaraachnoid space

Question 46

symptoms of SAH

Answer 46

bad headache nausea/vomiting dizziness neck pain pulsitile tinnitus double vision

Question 47

does an unruptured aneurism cause papilledema

Answer 47

no only a ruptered aneurysm can cause papilledema

Question 48

aside from the optic disc being pushed forward... papilledema is also caused by

Answer 48

axoplasmic stasis and extrusion from the cell membrane

Question 49

what can cause papilledema

Answer 49

anything that causes increased ICP bleeding tumors blocking CSF flow blood clots in dural venous sinuses blocking CSF flow

Question 50

a subdural hemorrhage causes

Answer 50

increased intracranial pressure and papilledema

Question 51

is a SDH a fast or slow bleed

Answer 51

slow bleed optic disc could look normal after trauma even if they do have SDH

Question 52

is a SAH bleed fast or slow

Answer 52

a fast arterial bleed pt may develop papilledema more quickly

Question 53

the most common presenting problem from an aneurysm is _______ and _________ into subarachnoid space

Answer 53

rupture and bleeding

Question 54

obstructive hydrocephalus

Answer 54

build up of CSF increased volume of cranial cavity increased intracranial pressure

Question 55

intracranial mass can compress _______ and cause increased intracranial pressure and papilledema

Answer 55

dural venous sinuses

Question 56

a mass of meninges. it tends to trail along the dura, causing a dural trail

Answer 56

meningioma

Question 57

venous sinus thrombosis is a blood clot in

Answer 57

the dural venous sinuses

Question 58

venous sinus thrombosis blocks drainage of

Answer 58

venous blood AND CSF -CSF can't drain out of cranial cavity and leads to increased intracranial pressure

Question 59

idiopathic intracranial hypertension - possible mechanism

Answer 59

increased pressure in the venous system keeps CSF from draining

Question 60

meningitis

Answer 60

inflammation of the meninges

Question 61

what symptom is seen with meningitis

Answer 61

neck pain / stiffness

Question 62

just like with the optic nerve, there is only _____ layer of dura surrounding the spinal cord

Answer 62

one

Question 63

around the spinal cord there is

Answer 63

arachnoid and pia and therefore a subarachnoid space