questions 4

Intracranial Hemorrhage

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Topic updated on 01/06/17 2:27pm

Epidural hematoma
  • Introduction
    • cause 
      • rupture of middle meningeal artery as result of trauma
        • branch of maxillary artery
        • commonly with skull fracture at pterion of temporal bone
      • rapid expansion with high arterial pressure
        • can lead to transtentorial herniation
  • Presentation
    • symptoms
      • momentary loss of consciousness
      • lucid period up to 48 hours
      • headache, nausea, hemiparesis
    • physical exam
      • CN III palsy
  • Evaluation
    • imaging
      • "biconvex disk" on CT
        • does not cross suture lines
        • can cross falx, tentorium
  • Treatment 
    • evacuation of blood/lower intracranial pressure
Subdural hematoma
  • Introduction
    • cause
      • rupture of bridging veins where they enter the superior sagittal sinus
        • results in slow venous bleeding below the dura mater
      • slow expansion with low venous pressure
        • delayed symptoms
    • populations at greatest risk
      • elderly individuals, alcoholics
        • atrophied brain makes veins more vulnerable
      • blunt trauma, shaken baby
  • Presentation
    • symptoms
      • nausea, headache
  • Evaluation
    • imaging
      • "crescent-shaped" on CT
        • can cross suture lines
        • cannot cross falx, tentorium
        • preservation of gyri due to low pressures
  • Treatment
    • evacuation of blood/lower intracranial pressure
  • Prognosis, Prevention, and Complications
    • death if blood is not evacuated
Subarachnoid hemorrhage
  • Introduction
    • cause
      • rupture of an aneurysms
        • commonly berry aneurysm
          • MC location is anterior cerebral or anterior communicating
        • populations at greatest risk
          • Marfan's, Ehlers-Danlos, APCKD or an AVM
  • Presentation
    • symptoms
      • complaints of "worst headache of my life"
  • Evaluation
    • LP
      • blood/yellow spinal tap
  • Treatment
    • evacuation of blood/lower intracranial pressure
    • calcium channel blockers
      • mediates risk of vasospasm following breakdown of blood 
        • 2-3 days post rupture
Parenchymal hematoma
  • Introduction
    • cause/contributing factors
      • hypertension
      • amyloid angiopathy 
      • diabetes mellitus
    • MC location is basal ganglia and internal capsule
  • Presentation
    • symptoms
      • based on mass effect of surrounding structures


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