Sketchy Path: Neuro - "Epidural Hematoma, Subdural Hematoma, & Subarachnoid Hemorrhage"

Question 1

Skull fractures are most common with ____________ hematomas.

Answer 1

epidural (like the cracked skull of the dural bumper car)

Question 2

The most vulnerable portion of the skull –and thus the most likely to fracture –is the ______________.

Answer 2

pterion (where four bones meet: the temporal, parietal, frontal, and sphenoid)

Question 3

The middle meningeal branches off of the _____________ artery.

Answer 3

external carotid

Question 4

The middle meningeal artery passes through the ____________.

Answer 4

foramen spinosum

Question 5

The dura mater is firmly adhered to the ____________ points.

Answer 5

suture (which is why epidural hematomas remain within suture boundaries, at least initially)

Question 6

True or false: the study of choice for suspected epidural/subdural hematomas is a contrast CT.

Answer 6

False

The study of choice is a non-contrast CT (like the non-con black cat hanging above the dural cars). Contrast will cause the tissues to look like blood and thus eliminate the differentiation of hemorrhage from parenchyma.

Question 7

The asymptomatic period in an epidural hematoma is called the ________________.

Answer 7

lucid interval

Question 8

Increased ICP –such as from an expanding epidural –can produce what symptoms?

Answer 8

• Headache (woman getting hit by piece of bumper)
• Nausea and vomiting (kid with green cheeks)
• Coma (guy passed out in bumper car arena)

Question 9

Uncal herniation causes what signs?

Answer 9

• Blown pupil (dilated due to absence of parasympathetic input)
• Down and abducted eye (due to interruption of the third cranial nerve and thus unopposed lateral rectus –CN VI)

(Think of the blackened-out headlight on the side of the crack in the dural bumper car.)

Question 10

Use of _____________ increases the risk of subdural hematoma.

Answer 10

anticoagulation (like the “WAR vet” shirt on the elderly man in the subdural car)

Question 11

Subdural hematomas have a _________________ appearance on CT.

Answer 11

crescentic (like the crescent-shaped water spill in the subdural cart)

Question 12

_______________ can present with a slow onset of headache, neurologic deficits, and even cognitive decline.

Answer 12

Chronic subdural hematomas (like the grandfather clock that is wincing and has a crescent moon on it)

Question 13

What is an organized subdural hematoma?

Answer 13

A chronic subdural hematoma that has been around so long it develops fibroblast membranes around it (represented by the fibrosis trees on either side of the grandfather clock)

Question 14

How can you diagnose an organized subdural hematoma?

Answer 14

A crescent-shaped space on NCCT that is black (because the blood has been evacuated but the fibrotic area is held in crescent shape)

(Think of the DARK moon on the clock, as opposed to the bright moons on the cats.)

Question 15

Which hematoma causes bleeding into the CSF?

Answer 15

Subarachnoid hemorrhages, because the CSF is beneath the arachnoid layer

(Think of the red CSF river beneath the spider.)

Question 16

Review the causes of SAHs.

Answer 16

• Ruptured Berry aneurysms
• AVMs
• Vasculitis

Question 17

______________ can cause nuchal rigidity due to meningeal irritation.

Answer 17

SAH (like the kid in the boat with the rigid neck and the zombie with the neck collar)

Question 18

A NCCT of someone with SAH will show _______________.

Answer 18

white around the parenchyma of the brain, especially in the ventricles near the circle of Willis

(Think of the spider web with white in it.)

Question 19

If the NCCT of someone with suspected SAH is negative, you need to do a _______________.

Answer 19

LP, which could show elevated opening pressure, xanthochromia, and RBCs (like the doctor with the yellow syringe)

Question 20

Why is xanthochromia a good indicator of SAH?

Answer 20

Because xanthochromia appears only after blood has sat in the CSF for a long time, not from a traumatic tap.

Question 21

Why do you give CCBs after an SAH?

Answer 21

The breakdown products of the blood, which will be adjacent to healthy blood vessels, can irritate the vessels and cause vasospastic stroke (typically one week after the bleed).

(Think of the kid SQUEEZING his mom’s red hair onto the brain ice cream beneath the Need MO’ DIPpIN ice cream.)

Question 22

List the risk factors for aneurysm formation.

Answer 22

• Menopause (like the woman behind the PAUSE button)
• Smoking (woman smoking)
• Drinking (she’s also drinking)
• Collagen disorders, like Ehlers-Danlos (like the collagen shark – with III gill markings –with LOoSe screws)
• ADPCKD (red balloons)