Neuro Flashcards
List the 6 layers/spaces of the skull from outside to inside
- Skull
- Dura mater
- Arachnoid mater
– Subarachnoid space - Pia mater
- Brain parenchyma
Between what layers do Epidural bleeds occur?
Skull and Dura mater
What is unique about Epidural bleeds?
They do NOT cross suture lines
How do Epidural bleeds arise?
Temporal bone fracture that lacerates the middle meningeal artery
Describe the patient presentation with an Epidural bleed
- Loss of consciousness
- Lucid (normal) interval
- Rapid DETERIORATION
What is the imaging choice for brain bleeds/trauma?
CT with NO CONTRAST
What is the imaging choice for brain bleeds/trauma? Contrast type?
CT with NO CONTRAST
How will an Epidural bleed look on CT?
Lens shaped – more spherical
Between what layers do Subdural bleeds occur?
Dura and Arachnoid mater
How do Subdural bleeds often occur?
Tearing of the bridging veins
In what patients are Subdural bleeds more common?
Older patients/alcoholics with atrophic brains
How will a Subdural bleed present?
Gradually worsening focal neuro deficit/altered mental status
How will a Subdural bleed look on CT?
Crescent shaped
What is the treatment for Epidural and Subdural bleeds?
Craniotomy/Craniectomy
Between what layers do Subarachnoid bleeds occur?
Arachnoid mater and Pia mater
– IN the Subarachnoid space
What is the most common cause of a Subarachnoid bleed?
Aneurysm
How will a patient present with a Subarachnoid bleed?
“Thunderclap headache”
– Sudden onset to maximum intensity very FAST
+/- signs of meningitis
How will a Subarachnoid bleed look on CT?
Bright white blood lining the gyri/sulci and basal cistern
Will there be surrounding gray (vasogenic edema) with a Subarachnoid bleed?
NO
If a Subarachnoid bleed is confirmed on CT, what test should be done next?
CTA to find the aneurysm
If a CT is (-) but you are concerned for a Subarachnoid bleed, what test should be done next?
Lumbar puncture
What often causes an Intraparenchymal Hematoma?
HTN related bleed in the lenticulostriate arteries
How will the patient present with an Intraparenchymal Hematoma?
Focal neuro deficit that looks like a stroke
How will an Intraparenchymal Hematoma look on CT?
Bright white blood in the brain that IS surrounded by dark gray (vasogenic edema)
Will there be surrounding gray (vasogenic edema) with Intraparenchymal Hematomas?
YES
Where are Basilar Skull fractures?
Base of skull or floor of face
What are 3 signs of a Basilar skull fracture?
Battle sign (bruise behind ears)
Raccoon eyes (bruise around eyes)
CSF leaking from nose/ears
What imaging (2) should be done when concerned for a Basilar skull fracture?
CT of the maxillary/facial region
CTA
What defines a concussion/TBI?
Trauma that results in change in neurologic function
How do concussions usually present?
Loss of consciousness +/- amnesia
How will the CT look with a concussion?
Normal – rules out bleed
Treatment for concussion?
Discharge and individual treatment plan
If you see punctate hemorrhages on the front/back of the brain, what is that called?
Intraparenchymal contusions
What causes Diffuse Axonal Injury?
Deceleration injury that shears the axons
How will the CT look with a Diffuse Axonal Injury?
Normal at first
The CT may be normal at first with a Diffuse Axonal Injury, however the patient will be?
Comatose usually
After a few days following a Diffuse Axonal Injury, what imaging should be done?
MRI
What is important to consider when medically treating Subarachnoid/Intraparenchymal bleeds?
Keep the BP LOW to prevent rebleeds/worsening of the bleed
