Neuro 2 Flashcards
Lucid interval is seen in what type of brain bleed?
Extradural
EDH = what artery mostly?
Middle meningeal artery
Why does an extradural haemorrhage lead to a fixed dilated pupil?
- important to understand (from the CBL)
The brief regain in consciousness is termed the ‘lucid interval’ and is lost eventually due to the expanding haematoma and brain herniation. As the haematoma expands the uncus of the temporal lobe herniates around the tentorium cerebelli and the patient develops a fixed and dilated pupil due to the compression of the parasympathetic fibres of the third cranial nerve.
EDH haemorrhage appearance on imaging:
On imaging, an extradural haematoma appears as a biconvex (or lentiform), hyperdense collection around the surface of the brain. They are limited by the suture lines of the skull.
Treatment of EDH:
Craniotomy and evacuation of the haematoma.
A chronic subdural bleed presents in what patient groups?
Rupture of the small bridging veins within the subdural space rupture and cause slow bleeding. Elderly and alcoholic patients are particularly at risk of subdural haematomas since they have brain atrophy and therefore fragile or taut bridging veins.
Presentation of a chronic subdural?
Presentation is typically several weeks to month progressive histories of either confusion, reduced consciousness or neurological deficit.
Management of chronic subdurals:
SDH has various management strategies depending on the size, location and extent of mass effect and is either conservative (monitor with serial CT) or surgical (drainage with burr holes).
If the chronic subdural is an incidental finding or if it is small in size with no associated neurological deficit then it can be managed conservatively with the hope that it will dissolve with time. If the patient is confused, has an associated neurological deficit or has severe imaging findings thensurgical decompression with burr holesis required.
Young child with a subdural haemorrhage think…
Non-accidental injury (shaken baby syndrome)
Todd’s paresis
Todd’s paresis, weakness for 24-48hrs following a seizure.
- typically after generalised tonic clonic
Jacksonian March
Jacksonian March - when symptoms start in one part of the body and then spread to another part.
- focal epilepsy
Jacksonian march is due to what lobe of the brain?
FRONTAL lobe
SUNCT presentation and treatment
SUNCT: lasts seconds and can have up to 200 per day responsive to NSAIDs
SUNCT presentation and treatment
SUNCT: lasts seconds and can have up to 200 per day responsive to NSAIDsa
A craniopharyngioma gives what visual field defect?
A craniopharyngioma gives a bitemporal inferior quadrantanopia visual field defect.
