Hematomas

Question 1

Epidural Hematoma

Answer 1

1. Clinically, the patient’s post-traumatic history is initial unconsciousness followed by rapid recovery. After a few hours, the increase in supratentorial cranial volume causes displacement of brain tissue (herniation).
2. A fracture at the pterion may rupture the middle meningeal artery: resulting hematoma compresses upon the adjacent cerebral hemisphere and cause a midline shift of the cerebral hemispheres (falx herniation) and/or an uncal herniation.

Question 2

Papilledema

Answer 2

Increased intracranial pressure applies a cuff-like pressure to the small veins on the optic nerve via of the adjacent subarachnoid extension.

The decreased venous drainage from the retina results in edema of the retina and swelling of the optic disc (papilledema).

a subdural hematoma can cause papilledema but any space occupying mass that increases intracranial pressure will do so when you think about it.

Question 3

Subdural Hematoma

Answer 3

1. signs and symptoms of subdural hematomas are the same as epidural hematomas
2. their temporal onset may be delayed for days or weeks, and the progression of signs and symptoms much more insidious. The delay is due to the slower accumulation.
3. Subdural hematomas can have an acute onset. The patients display various states of lethargy, seizures or headaches.
4. children, subdural hematomas are often associated with a skull fracture.
5. In the elderly minor head trauma may result in a subdural hematoma due to more fragile blood vessels.

Question 4

Subarachnoid Hemorrhage

Answer 4

1. ll of the major blood vessels supplying the CNS pass through or course in the subarachnoid space.
2. Rupture of one of these vessels in this space is called a subarachnoid hemorrhage
3. indicated by the presence of erythrocytes in the CSF.
4. Cerebral contusion may also result in subarachnoid hemorrhage.
5. CSF is usually sampled by inserting a needle into either the cerebellomedullary or lumbar cisterns. If a subarachnoid hemorrhage has recently occurred, then blood will be present in the CSF sample.

Question 5

1. 2/3s of cases
2. Thrombosis of the posterior portion of the superior venous sinus or right transverse venous sinus
3. Thrombosis of the posterior portion of the straight venous sinus or left transverse venous sinus

Answer 5

1. In two-thirds of the cases:
   
   1. the superior sagittal sinus empties directly into the right transverse sinus & the straight sinus drains directly into the left transverse sinus.
2. results in cortical ischemia and/or necrosis.
3. results in ischemia and/or necrosis of structures in the deep cerebrum: USUALLY FATAL

Question 6

lateral ventricles

1. corpus collosum
2. septum pellucidum
3. anterior horn/inferior horn
4. how hydrocephalus is treated

Answer 6

1. corpus collosum is the lateral wall; septum pell. separates them from one another
2. anterior horn of the lateral ventricle is located in the center of the frontal lobe.
3. the inferior horn is located in the center of the temporal lobe.
4. A small tube or shunt may be inserted into the ventricle to shunt excessive CSF from the ventricle to either the venous system or peritoneal cavity.

Question 7

1. the third ventricle is between the
2. the left lateral ventricles are in
3. the fourth ventricle
4. located adjacent to the midline below the fornix
5. the boundary between the tectum and the midbrain tegmentum
6. astrocytomas

Answer 7

1. thalami
2. each cerebral hemisphere
3. is between the cerebellum and the pon
4. interventricular foramen of Monroe
5. cerebral aquaduct sylvius
6. common midbrain tumor that can obstruct cerebral aquaduct of sylvius

Question 8

formed by the tegmentum of the metencephalon

Answer 8

fourth ventricle

shaped like a four-sided pyramid. Its base (anterior wall), the rhomboid fossa, is formed by the tegmentum of the metencephalon and the apex (fastigium) is directed towards the cerebellum.

Question 9

bilateral anesthesia of the shoulder and upper limbs.

Answer 9

1. syringomyelia
2. in the central canal
3. CC extends from C5-C8
4. cul de sac
5. further cavitation caused syringomyelia

Question 10

1. cisterna magna
2. cisterna ambiens

Answer 10

cerebellomedullary cistern (cisterna magna): large CSF filled space just above the foramen magnum and posterior to the medulla.

superior cistern (cisterna ambiens): located just posterior to the pineal gland.

Question 11

The presence of more than six lymphocytes or erythrocytes in CSF

Answer 11

is abnormal

Question 12

1. CSF in the ventricles =
2. CSF in the ventricular system =

Answer 12

1. 20-25 ml
2. 140 ml

Question 13

subarachnoid hemorrages: potential outcome

Answer 13

the subarachnoid villi become clogged with rbcs which undergo lysis. the release of cellular content into the CSF alters the ionic balance and creates a difficult to diagnose chemical meningitis, sterile meningitis, complete with neck pain

Question 14

Sundown Eyes

Answer 14

this is when a child has hydrocephalus and it compresses on a cranial nerve

Question 15

External Hydrocephalus

Answer 15

excessive accumulation of CSF in the subarachnoid space with concomitant enlargement of that space by compression of the CNS. It may be supratentorial, infratentorial, or both.

Question 16

Supratentorial external hydrocephalus

Answer 16

is most commonly associated with senile atrophy of the cortex, e.g., Alzheimer’s disease.

an excessive accumulation of CSF in the subarachnoid space with concomitant enlargement of that space by compression of the CNS. It may be supratentorial, infratentorial, or both.

Question 17

Infratentorial external hydrocephalus

Answer 17

is seen in combination with communicating hydrocephalus.

s an excessive accumulation of CSF in the subarachnoid space with concomitant enlargement of that space by compression of the CNS. It may be supratentorial, infratentorial, or both.

Question 18

Internal Hydrocephalus

1. cerebral aqueduct obstruction
2. medial-lateral foramina obstructions
3. interventricular foramen obstruction

Answer 18

sometimes called noncommunicating hydrocephalus: not drain into the subarachnoid space.

may be due to obstruction of the

interventricular foramen: third ventricle choroid
plexus ependymoma

cerebral aqueduct: midbrain astrocytoma

medial and lateral foramina: Arnold-Chiari malformation, Dandy-Walker cyst

All result in dilation of the ventricle(s) proximal to the obstruction.

It may be present in combination with an infratentorial external hydrocephalus (communicating hydrocephalus)

Question 19

communicating hydrocephalus

Answer 19

and internal hydrocephalus that communicates with an external infratentorial hydrocephalus

Question 20

The narrow space between the tentorial notch and the midbrain becomes obstructed due to adhesions; fibrosis occurs in the subarachnoid spaces from past inflammation (e.g., infantile meningitis), cerebral edema, and/or uncal herniation. In this condition. What kind of hydrocephalus do we anticipate?

Answer 20

Communicating hydrocephalus

1. In this condition, CSF is free to move through the ventricular system into the infratentorial subarachnoid space, but it cannot circulate over the cerebrum to be resorbed at the arachnoid villi adjacent to and in the superior sagittal sinus.