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OD1 Fall > head and neck lecture 14 > Flashcards

head and neck lecture 14 Flashcards

1
Q

where do epidural hematomas occur

A

bleeding on top of dura (bw dura and skull)

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2
Q

What is the weakest part of the skull?

A

pterion

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3
Q

where is pterion bone

A

in the temporal fossa on external skull

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4
Q

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

A

middle meningeal artery

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5
Q

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

A

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

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6
Q

where do the middle meningeal artery come from

A

foramen spinosum

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7
Q

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

A

foramen spinosum

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8
Q

can you see the middle meningeal artery itself in the dura

A

yes

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9
Q

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

A

epidural space
epidural hematoma

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10
Q

an epidural hematoma occurs bw

A

the dura and the skull

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11
Q

epidural hematoma is most likely seen in

A

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

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12
Q

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

A

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

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13
Q

separates right and left halves of the brain

A

falx cerebri

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14
Q

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

A

temporal lobe

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15
Q

what is the most medial projection of the temporal lobe

A

uncus

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16
Q

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

A

tentorial notch
forament magnum

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17
Q

the ______ is found in the core of the brainstem

A

reticular formation

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18
Q

the reticular formation is responsible for

A

the awakened state = consciousness

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19
Q

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

A

foramen magnum compressing the medulla with its vital centers

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20
Q

where is the reticular formation found

A

in dorsal brainstem

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21
Q

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

A

dilated pupil

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22
Q

what should pupils do when you shine light into eyes

A

constrict

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23
Q

what should eyes do in dim

A

dilate

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24
Q

a compressive CN 3 palsy can present initially as just a

A

dilated pupil

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25
Q

what fibers travel outside of CN 3

A

parasympathetic nervous fibers

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26
Q

epidural hematoma affects

A

middle meningeal artery = arterial blood under high pressure

27
Q

subdural hematoma affecs

A

bridging veins = venous blood under less pressure

  • slower bleed than arterial blood
28
Q

patients with a subdural hematoma may not become symptomatic until

A

a few weeks after an episode of trauma

29
Q

where does a subdural hematoma take place

A

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

30
Q

in a subdural hematoma, is it venous or arterial blood

A

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

it is venous blood

31
Q

does a subdural hematoma cross midline

A

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

32
Q

a subdural hematoma is the collection of blood between

A

the inner layer of dura and the arachnoid

33
Q

what causes a subdural hematoma

A

a rupture of the cortical bridging veins

34
Q

subdural hematomas are most common in

A

-pt treated with anticoagulants

  • elderly and alcoholics with atrophy
35
Q

if subdural hematomas are not treated they can damage the

A

reticular activating system

36
Q

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

A

external cortical bridging veins

37
Q

subdural hematomas occur due to

A

trauma

38
Q

external cortical (bridging) veins drain into

A

the superior saggital sinus

39
Q

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

A

no

40
Q

what are the signs/symptoms of a SDH

A

-severe headache
-vomiting
-dizziness
-sudden weakness arm or leg
dilated pupil

RAS compromised:
decreased consciousness
confusion
inability to wake up

41
Q

the headache associated with a SSH is due to

A

meningeal irritation innervated by CN 5

42
Q

who is most at risk for a SDH

A

people who are fragile

-the elderly
- infants
- anyone who sustains severe head trauma

43
Q

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

A

terson syndrome

44
Q

subarachnoid hemorrhage causes increased

A

intracranial pressure and papilledema

45
Q

the most common presenting problem from an aneurysm is

A

rupture with bleeding in subaraachnoid space

46
Q

symptoms of SAH

A

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

47
Q

does an unruptured aneurism cause papilledema

A

no
only a ruptered aneurysm can cause papilledema

48
Q

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

A

axoplasmic stasis and extrusion from the cell membrane

49
Q

what can cause papilledema

A

anything that causes increased ICP

bleeding
tumors blocking CSF flow
blood clots in dural venous sinuses blocking CSF flow

50
Q

a subdural hemorrhage causes

A

increased intracranial pressure and papilledema

51
Q

is a SDH a fast or slow bleed

A

slow bleed

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

52
Q

is a SAH bleed fast or slow

A

a fast arterial bleed
pt may develop papilledema more quickly

53
Q

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

A

rupture and bleeding

54
Q

obstructive hydrocephalus

A

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

55
Q

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

A

dural venous sinuses

56
Q

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

A

meningioma

57
Q

venous sinus thrombosis is a blood clot in

A

the dural venous sinuses

58
Q

venous sinus thrombosis blocks drainage of

A

venous blood AND CSF

-CSF can’t drain out of cranial cavity and leads to increased intracranial pressure

59
Q

idiopathic intracranial hypertension - possible mechanism

A

increased pressure in the venous system keeps CSF from draining

60
Q

meningitis

A

inflammation of the meninges

61
Q

what symptom is seen with meningitis

A

neck pain / stiffness

62
Q

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

A

one

63
Q

around the spinal cord there is

A

arachnoid and pia and therefore a subarachnoid space

OD1 Fall (5 decks)

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