ssrpk
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A 22 year male college student suffers head trauma after being thrown from a motorcycle and briefly loses consciousness. A neurological exam given in the emergency room is normal and the patient is discharged. Several hours later, he is taken back to the emergency room because he has become drowsy and confused. His right pupil is 5mm, but his left pupil is only 3mm; both react to light. Muscle stretch reflexes are elevated in the left lower limb, and on his return to the emergency room, the patient's left lower limb seemed weaker than the right. A CT scan reveals intracranial bleeding that forms a lens shaped hematoma between the skull and the lateral aspect of the right hemisphere and the subsequent herniation of the brain tissue.
#1-How would you characterize the intracranial bleeding?
a) subdural hematoma
b) rupture of an AVM
c) Epidural hematoma
d) Subarachnoid hemorrhage
e) Interventricular hematoma
#2-How would you characterize the herniation in this patient?
a) subfalcine
b) Arnold-Chiari
c) Tentorial
d) Tonsillar
e) Kernohan's
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| cyra
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1.c
2.c....(not sure about this one though)
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| ssrpk
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very good, both are correct!
it's tentorial, tht has involved CN III, moreover there's some evidence of compression on the midbrain surface tht may hv affected the cortico-spinal tracts [inc. stretch refexes]
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| GMOB
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This patients clinical history is characteristic of epidural hematoma. Trauma is followed by a brief period, up to 24 hours, of lucidity then the patient collapses. called "talk and die" syndrome. I think it's mostly caused by lesion to Medial Meningeal Artery by direct blows to the lateral aspect of the skull.
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| ssrpk
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it's middle meningeal artery , rest was kool 
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| sethigulshan
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Middle meningeal artery is a branch of what artery, and what foramen it passes thru?
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| ssrpk
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maxillary artery!
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| sethigulshan
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it passes thru the foramen spinosum.
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| sethigulshan
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so
What is the cause of subdural hematoma?
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| ssrpk
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rupture of bridging veins, venous blood don't hv enough pressure to rapidly seperate out the overlying dura (unlike epidural) therefore, in a clinical case ,it will always be late appearing, generallly several weeks.
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| sethigulshan
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Perfect!!
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