Neurologic System Flashcards
0
Q
Subdural Hematoma
A
- Blood collection under the dura
- Etiology: tearing of bridging veins that pass through the space between the cortical surface and the dural venous sinuses or injury to the brain surface with resultant bleeding from cortical vessels
- Acute: sx in 24hrs
- Subacute: sx in 3-14 days
- Chronic: sx after 2 wks
- Tx: Craniotomy with clot evacuation
- CT findings: curved crescent shaped hematoma
1
Q
Subarachnoid Hemorrhage
A
- Blood below the arachnoid membrane and above the pia
- Etiology: Trauma is #1 cause, ruptured berry aneurysm(saccular outpouching of vessels in the circle of Willis usually at bifurcation; occurs most often at anterior communicating artery; polycystic kidney disease and connective tissue disorders such as Marfan’s syndrome increase risk of berry aneurysm), arteriovenous malformation(AVM; congenital abnormality of the vasculature with connections b/t arterial and venous circulations without interposed capillary network).
- Sx: “worst HA of my life”, neck pain, positive Kernig’s and Brudzinski’s signs, LOC, N/V, photophobia
- Workup: Head CT, LP, arteriogram to look for aneurysms or AVMs
- Complications: brain edema–> increased ICP, rebleeding, vasospasm
- Tx vasospasm: Nimodipine
- Tx aneurysms: surgical: place metal clip on the aneurysm or balloon occlusion or coil embolization.
- Tx AVMs: surgical, pre-op embolization, if surgically inaccessible radiosurgery.
2
Q
Epidural Hematoma
A
- Collection of blood between the skull and dura
- Etiology: association with skull fx as bone fragments lacerate meningeal arteries
- Associated with middle meningeal artery
- Classic hx: LOC followed by lucid interval followed by neurologic deterioration
- CT findings: lens shaped hematoma
- Surgery: surgical evacuation. Indicated in any symptomatic pt or any hematoma >1cm.