SECRETS Neurology - Hematomas & Bell's Palsy

Question 1

Epidural hematoma - vessel

Answer 1

middle meningeal artery

fracture of temporoparietal bone

Question 2

subdural hematoma - vessel

Answer 2

bridging veins that connect subarachnoid space and dural venous sinuses

Question 3

epidural hematoma assoc

Answer 3

lucid interval

Question 4

subdural hematoma assoc

Answer 4

elderly people

Question 5

subdural hematoma vs epidural hematoma timing

Answer 5

subdural = slow
epidural = fast

Question 6

layers of meninges

Answer 6

outermost = dura (periosteal & meningeal layers)
middle = arachnoid layer (contains subarachnoid space
innermost = pia (attached directly to brain parenchyma)

Question 7

subdural hematoma shape/location

Answer 7

crescent-shaped
follows contours of skull
can cross suture lines

between dura and pia

Question 8

epidural hematoma shape/location

Answer 8

biconcave disk
limited by suture lines

between skull and dura

Question 9

UMN innervation of face

Answer 9

facial nerve

lower face = contralateral
upper face = bilateral

Question 10

Bell’s palsy

Answer 10

paralysis of facial nerve

generally due to inflammation within facial canal

Question 11

bell’s palsy sx

Answer 11

paralysis of muscles of facial expression
loss of innervation to stapedius = louder noise
loss of taste in anterior 2/3 tongue
absent corneal reflex (efferent path via facial nerve)

Question 12

tongue innervation
touch
taste
motor

Answer 12

touch anterior 2/3 = CNV
taste anterior 2/3 = CNVII
touch/taste posterior 1/3 = CNIX
motor = CNXII

Question 13

causes

Answer 13

mumps - parotid gland inflammation

acoustic neuroma (schwannoma) = arise next to where facial nerve exits pons
sx = hearing loss, balance probs

lyme disease = stage 2

Question 14

bell palsy vs stroke

Answer 14

stroke = spare upper face (bilateral UMN)

bell = entire half of face (contra LMN)