Y4 Haematoma

Question 1

what vessels cause an extradural haematoma?

Answer 1

middle meningeal artery

Question 2

what vessels cause an subdural haematoma?

Answer 2

bridging veins between cortex and sinuses

Question 3

what are some risk factors of subdural haematomas?

Answer 3

Elderly: brain atrophy
􏰀Falls: epileptics, alcoholics
􏰀Anticoagulation

Question 4

what is seen on CT with a subdural haematoma ?

Answer 4

Crescentic haematoma over one hemisphere

Question 5

what is seen on CT with a extradural haematoma ?

Answer 5

􏰀 Lens-shaped haematoma

Question 6

what is the treatment of a subdural haematoma?

Answer 6

1st line: irrigation/evacuation via burr-hole craniostomy

2nd line: craniotomy

Question 7

what is the treatment of a extradural haematoma?

Answer 7

Neuroprotective ventilation (O >100, CO 35-40)

􏰀 Consider mannitol (1g/kg IV via central line)

􏰀 Craniectomy for clot evacuation and vessel ligation

Question 8

what do people die of with brainstem compression?

Answer 8

cardiorespiratory arrest

Question 9

what is a DD of a subdural haematoma?

Answer 9

Stroke
􏰀 Dementia 􏰀
SOL (space occupying lesion)

Question 10

what mechanism usually causes an extradural haematoma?

Answer 10

trauma

Question 11

what is the presentation of an extradural haematoma ?

Answer 11

lucid interval
headache, vomiting, confusion, seizures
brain stem compression (cushions response)

Question 12

what is the presentation of subdural haematomas ?

Answer 12

headache
fluctuating consciousness
unsteadiness

Question 13

what is the most common venous sinus thrombosis ?

Answer 13

superior sagittal sinus

Question 14

what does a transverse sinus thrombosis present with?

Answer 14

Headache ± mastoid pain, focal neuro, seizures,

papilloedema

Question 15

what does a superior sagittal sinus thrombosis present with?

Answer 15

Headache, vomiting, seizures, ↓ vision, papilloedema

Question 16

what does a sigmoid sinus thrombosis present with?

Answer 16

Cerebellar signs, lower CN palsies

Question 17

what does a cavernous sinus thrombosis present with?

Answer 17

Headache, chemosis, eyelid oedema, proptosis, painful

ophthalmoplegia, fever

Question 18

what is DD of a venous sinus thrombosis ?

Answer 18

SAH
􏰀 Meningitis
􏰀 Encephalitis
􏰀 Intracranial abscess
􏰀 Arterial stroke

Question 19

state some causes of sinus thrombosis?

Answer 19

Pregnancy / puerperium 􏰀 OCP
􏰀 Head injury
􏰀 Dehydration
􏰀 Intracranial / extracranial malignancy 􏰀 
Thrombophilia

Question 20

what is the management of intracranial sinus thrombosis?

Answer 20

LMWH → warfarin (INR 2-3)

Question 21

what investigations can be done for intracranial sinus thrombosis ?

Answer 21

CT/MRI venography: absence of a sinus􏰀

LP ↑ pressure, may show RBCs and xanthochromia

Question 22

what will a cerebral abscess look like on CT/MRI?

Answer 22

CT/MRI: ring-enhancing lesion