Wk11 Suspected Bleed

Question 1

Where is the middle meningeal artery?

Answer 1

• The third branch of the first portion of the maxillary artery.
• Branches off the maxillary artery in the infratemporal fossa.
• Runs through the foremen spinosum to supply the dura mater (outer meningeal layer) and the calvaria.

Question 2

How does the MMA develop?

Answer 2

• Develops via angiogenesis
• Receives guidance from vascular endothelial growth factor and other growth factors.
• During development, a series of aortic arch arise, arranged from cranial to caudal.

Question 3

Epidural and subdural bleeds

Answer 3

Epidural and subdural hematomas are produced by ruptures of blood vessels.
- Epidural hematomas - most common cause is an injured middle meningeal artery. Head injuries can rupture the artery.
- Subdural hematomas - usually due to bleeding from veins that drain blood away from the surface of the brain.
Signs include:
• Head injury or trauma followed by loss of consciousness
• a period of alertness, then rapid deterioration back to unconsciousness.
• Nausea or vomiting.
• Weakness in part of the body, usually on the opposite side from the side with the enlarged pupil

Question 4

Treatment & recovery

Answer 4

• The outcome of subdural hematoma is worse than that of epidural hematoma in children because of associated brain injuries & complications of secondary injury. So surgical intervention may be necessary.
• Surgery recommended to remove an epidural hematoma in most cases.
  This usually involves a craniotomy - part of the skull opened to remove the hematoma & reduce the pressure on your
  brain. Recovery:
• Most recovery happens in first 6 months most recovery.
• Improvement over 2 years.
• If there is brain damage, full recovery isn’t likely.

Question 5

Tonsillar hematomas

Answer 5

Spontaneous tonsillar haemorrhage = A continuous bleed for more than an hour, or more than 250ml of blood loss regardless of the duration of bleeding.
- associated with various pathological conditions, including acute and chronic tonsillitis, parapharyngeal abscess and tonsil cancer.
- most common from ages 10-20.
- caused by a bacterial or viral infection.
Signs: bleeding from mouth or nose, frequent swallowing and vomiting bright red or dark brown blood.
Treatment:
- Surgical drainage and bleeding control.
- In general, antibiotherapy is started prophylactically due to surgical intervention. Recovery = approx. 14 days with treatment

Question 6

Intracranial pressure

Answer 6

Intracranial pressure = Growing pressure inside the skull.

• Can affect the brain if left untreated
• Can cause an increase in the intracranial pressure (ICP)
• Due to hydrocephalus, swelling/bleeding/aneurysm in brain, stroke, hypertension etc.
• Leads to brain injury, seizures, coma and maybe death.

Question 7

How to spot ICP

Answer 7

• Pupils that do not respond to light in the usual way
• Behavioural changes
• Reduced alertness
• Sleepiness
• Muscle weakness
• Speech or movement difficulties
• Blurred vision

Question 8

Treatment and recovery for ICP

Answer 8

Treatments include:
- Draining excess cerebrospinal fluid with a shunt, to reduce pressure on the brain that hydrocephalus has caused
- Medication that reduces brain swelling such as mannitol
- Surgery (less commonly) to remove a small section of skull to relieve pressure.
• Chronic ICP- persistent long lasting and can lead to permanent vision loss in some cases.
• ICP- after surgery, needs to monitored for several days
Minnie could either have an epidural or subdural bleed, or intracranial pressure.
- A head CT or MRI or ECG can help to access brain activity for an epidural or subdural bleed.
- For ICP, a spinal tap or CT or MRI to test.