Neurology

Question 1

Cpx of Subarachnoid Hemmorhage

Answer 1

Abrupt onset of “worse headache of their life” or “thunderclap” headache

Question 2

What diagnostic imaging is needed in Subarachnoid Hemorrhage?

Answer 2

noncontrast CT scan: Blood = white

Question 3

What should you do if CT is negative for subarachnoid hemorrhage?

Answer 3

Lumbar puncture

Question 4

MCC of subarachnoid hemorrhage?

Answer 4

ruptured aneurysm

Question 5

Subarachnoid Hemorrhage tx

Answer 5

Nimodipine (decreases vasospasm)

Question 6

Patient will present as → a 24-year-old snowboarder strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely. His CT scan demonstrates a lens-shaped, biconvex hyperdensity which does not cross the suture lines.

What dz is this?

Answer 6

Epidural Hematoma

Question 7

What is the cause of epidural hematoma?

Answer 7

Caused by a traumatic intracranial hemorrhage following temporal bone skull fracture (75% of cases) resulting in tearing of the middle meningeal artery

Question 8

Blood in the space between the dura and the skull

What dz?

Answer 8

Epidural Hematoma

Question 9

What is the initial diagnostic study for epidural hematoma?

Answer 9

CT scan of the head w/o contrast

Question 10

What diagnostic test is contraindicated in a pt w/epidural hematoma?

Answer 10

Lumbar puncture due to increased risk of brain herniation

Question 11

What will you see on CT scan of head w/o contrast for an epidural hematoma?

Answer 11

Biconvex/lens shaped epidural hematoma

Question 12

Tx for epidural hematoma

Answer 12

Craniotomy + Hematoma evacuation

Question 13

What intracrainial hematoma does not cross suture lines?

Answer 13

Epidural Hematoma

Question 14

A patient who has a subdural hematoma will have a hx of what?

Answer 14

alcoholic

Question 15

What is a subdural hematoma?

Answer 15

intracranial venous hemorrhage that often results after trauma causing the emissary veins to tear

Question 16

Patient will present as → a 74-year-old female who is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the emergency department. Her daughter states that the patient fell in her kitchen 2 days ago, but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient’s left pupil is dilated. CT shows crescent shaped, concave hyperdensity.

What dz?

Answer 16

subdural hematoma

Question 17

an elderly patient with a history of multiple falls who is now presenting with neurological symptoms

Cpx of which dz?

Answer 17

Subdural Hematoma

Question 18

Dx for subdural hematoma

Answer 18

CT shows crescent shaped, concave hyperdensity that extends across suture line

Question 19

What is tx in small subdural hematomas with mild symptoms?

Answer 19

observation + repeated head imaging tests

Question 20

Severe subdural hematoma tx

Answer 20

surgery:

1. Burr hole trephination: A hole is drilled in the skull over the area of the subdural hematoma, and the blood is suctioned out through the hole.
2. Craniotomy: A larger section of the skull is removed, to allow better access to the subdural hematoma and reduce pressure. The removed skull is replaced shortly after the procedure.
3. Craniectomy: A section of the skull is removed for an extended period of time, to allow the injured brain to expand and swell without permanent damage (rarely used).