Hematomas Herniations and Hemorrhages Stephens T#2

Question 1

What is the glasgow coma scale?

Answer 1

Standard to determine level of consciousness

Question 2

What three things can be abrupt onset

Answer 2

trauma vasuclar and infectious

Question 3

Episodic onset

Answer 3

intermittent relapsing episodes, MS is an example, or vertebrobasilar insufficiency

Question 4

When testing Sensory to the face by palpating the temporalis and masseter and the patient does not feel it, what nerve is damaged?

Answer 4

trigeminal

Question 5

How do you test facial nerve?

Answer 5

Ask them to use any of their facial muscles

Question 6

Unilateral hearing is impaired in your patient, what nerve could be damaged?

Answer 6

VIII

Question 7

How do you tell damage to the vagus?

Answer 7

Dysphonia, Dysphagia, or perform a laryngoscopy

Question 8

Patient has inability to shrug shoulders, flex and rotate head to the opposite side, what nerve is damaged?

Answer 8

Spinal Accessory

Question 9

Tongue deviates to the right side when protruded, what nerve is damaged?

Answer 9

Right hypoglossal

Question 10

What is the manifestation of a subarachnoid hemorrhage?

Answer 10

• Abrupt onset of signs
• Bursting headache
• vomit
• changes in conscioussness or convulsion
• bradycardia, with increased HR BP and Temp

Neurologic findings:

• Kemig’s sign
• Neck rigidity
• unequal pupils and slow reaction to light
• absent DTR’s

Question 11

SAH neurologic findings, what causes primary and seondary focal signs?

Answer 11

Primary: ischemia

Secondary: destruction by rupture compression by a clot

Question 12

Where do most cerebral aneurysms occur?

Answer 12

Anterior circularion which is usually ICA

Question 13

In the US what is standard for suspecting SAH?

Answer 13

CT and lumbar puncture

Question 14

What is Lateral Medullary Wallenburg Syndrome?

Answer 14

• Thrombosis of PICA
• Displacement of the PICA on angiograms of posterior cranial fossa can indicate a tumor

Question 15

What is the significance of the Greater Anterior Artery of Adamkiewicz?

Answer 15

• It supplies blood to cervical and lumbar enlargements
• Major supply to the inferior two thirds of the spinal cord!!
• It can be compromised with a thorocolumbr fracture or when repairing an abdominal aortic aneurysm
  
  • occlusion or damage can result in parapalegia

Question 16

Veins of the spinal cord collectively drain into ____.

Answer 16

Internal Venous Plexus of Batson located in the epidural space. From here it goes to intervertebral veins and then segmental veins

Question 17

What drains most of the coretex of the lateral aspect of the cerebral hemispheres?

Answer 17

Superficial middle cerebral vein

Question 18

What is the clinical significance of the Great vein of Galen?

Answer 18

It drains most of the deep cerebrum so if it becomes obstructed it is typically fatal. It can also become dilated and form a venous varix.

• Great vein varix can compress pineal body and posterior commissure

Question 19

What area does the superior sagittal sinus drain?

Answer 19

• Most of cerebral cortex

Question 20

What area does the straight sinus drain?

Answer 20

• It receives great cerebral vein of galen
• Straight drains into left transverse

Question 21

Where does the superior sagittal sinus empty into and the straight?

Answer 21

• Right transverse
• Left transverse

Question 22

What does thrombosis of the posterior portion of the straight venous sinus or left transverse sinus result in?

Answer 22

• Results in ischemia and/or necrosis of deep brain cerebrum structures, this is usually fatal

Question 23

What does throombosis of posteior portion of superior sinus or right transverse sinus result in?

Answer 23

Cortical ischemia and/or necrosis

Question 24

What is a falx herniation?

Answer 24

It is also called a midline shift, this occurs when the cingulate gyrus to herniate across the midline below the free edge of the falx cerebri

Question 25

What is a tentorial or uncal herniation?

Answer 25

• When profuse high pressure bleeding occurs and fills the epidural space it presses on the adjacent cerebral hemisphere, causing the cerebrum to herniate under the falx cerebri &/or through the tentorial notch.
• When the uncus herniates through it compresses and displaces the reticular formation so paitients have a progressive decrease in their consciousness

Question 26

What is a tonsillar herniation?

Answer 26

• When there is a mass or the space is expaning in the posterior cranial fossa it can cause the cereballar tonsil to herniate throught the foramen magnum comressing the lower medulla upper cervical spinal cord.
  
  • Arnold Chiari Malformation