Traumatic Intracranial Hematomas Flashcards
What is this hematoma?
Epidural hematoma
What are the presenting features of an epidural hematoma?
– headache
– deteriorating conscious state
– focal neurological signs (dilating pupil, hemiparesis)
– change in vital signs (hypertension, bradycardia)
What are some focal neurologic signs you may see in a patient with epidural hematoma?
– temporal hematoma: progressive contralateral spastic hemiparesis and ipsilateral dilated pupil
– Frontal hematoma: deterioration of consciousness and pupil abnormalities
– Posterior fossa: May cause sudden respiratory failure
What will CT show for epidural?
– hyperdense
– biconcave
– white hematoma
– compression of brain and distortion of lateral ventricle
How do you treat epidural hematoma?
– no delay in evacuation of hematoma
– if no time for imaging then give mannitol or furosemide then operate
– operation: craniotomy with burr holes
What are the classifications of subdural hematomas?
– Acute: less than 3 days
– Subacute: 4 to 21 days
– Chronic subdural hematoma: more than 21 days
What are the CT features of an acute vs chronic subdural?
acute: hyperdense (white) helmatoma
chronic: hypodenise (dark)
What is the presentation of an acute subdural vs chronic subdural?
acute: decrease in conscious state and/or increase n lateralizing signs
chronic: hx of head injury (+/-) with
– raised ICP without significant FOCAL localizing signs BUT with nausea/vomiting/drowsiness
– Fluctuating drowsiness
– Progressive dementia (more rapid and progressive)
What are the signs of violent shaking of infant?
– subdural hematoma i.e. laceration of bridging cerebral veins
– listlesness
– irritability
– failure to thrive
