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Transcript of Intracranial bleeds
Epidural hematoma A 2-month-old male infant, previously healthy, presents to the emergency room with a seizure and difficulty breathing noted by his father. Mother went to work, and left the infant with her husband and infant's 3-year-old sibling. Father states that he put the infant down for a nap and found him 1 hour later having a seizure. Emergency medical technicians found the infant pale and bradycardic, and intubated the child at the scene. In the community hospital, lorazepam was given to control ongoing seizure activity. Physical exam is unremarkable except for the neurologic exam, which reveals brisk reflexes and Glasgow Coma Scale of 10/15. Ophthalmologic exam reveals bilateral multilayer retinal hemorrhages. Shaken Baby syndrome -
Subdural hematoma A 43-year-old woman complains of a sudden, excruciating headache. The headache is diffuse, intense, and accompanied by nausea and vomiting. She describes the headache as the worst headache of her life. Epidural Hematoma:
Middle meningeal artery
Rapid expansion due to systemic arterial pressure (can cause transtentorial herniation and CN III palsy)
Lucid intervals, patients with temporal bone fractures
CT: Lens shape Subdural Hematoma:
Bridging Veins that drain into the dural venous sinus
Slow venous bleeding
Elderly individuals, alcoholics, falls, shaken baby, whiplash (acute deceleration injuries)
CT: Crescent shaped Subarachnoid Hemorrhage
Rupture of aneurysm
Rapid time course
AVM, Marfan's, "worst headache of my life"
CT: "star of death" or "dead chicken sign"
RX: Craniotomy (surgical clipping) or endovascular coiling Intracranial bleeds Presenter: John Le MSIII Epidural Hematoma Subdural Hematoma Subarachnoid Hemorrhage Sharon Stone -
Subarachnoid Hemorrhage Treatment is surgical hematoma evaculation:
Craniotomy, burr hole (trephination) w/ catheter 1. An older man with a longstanding history of atrial fibrillation treated with warfarin is brought into the emergency department by his carer, who states his concern about the patient's confusion at home. The carer describes frequent falls over the last several months and feels that the patient is dropping utensils out of his right hand. On neurological examination, his pupils are equal, round, and reactive to light. He has a right-sided pronator drift and is weaker on his right side than on his left. His mental status testing reveals poor concentration and attention, and impaired short- and long-term recall and registration.
A) Epidural Hematoma
B) Subdural Hematoma
C) Subarachnoid Hemorrhage
D) Intra-axial hemorrhage 2. A 22-year-old man falls while skateboarding and strikes the right side of his head against the concrete. On physical examination only a minor scalp abrasion is present at the site of the impact, with minimal bleeding that stops in a few minutes. He is initially alert following this accident, but then became unconscious 30 minutes later.
These events are most likely to be associated with damage to which of the following:
A) Bridging veins
B) Cavernous sinus
C) Great vein of Galen
D) Inferior cerebellar artery
E) Middle meningeal artery
F) Ophthalmic branch of external carotid artery References:
1.Fundamentals of Diagnostic Radiology. Author: William E. Brant, Clyde A. Helms
2.Epidural Hematoma in Emergency Medicine at Medscape. Author: Daniel D Price. Updated: Nov 3, 2010
3.First Aid for the USMLE Step 1 2012. Author: Tao Le
4.Wagner AL. 2006. "Subdural Hematoma." Emedicine.com. Retrieved on February 6, 2007.
5."Natasha Richardson dies aged 45". BBC News. March 19, 2009. Retrieved May 2, 2010.
6.Mike Falcon (October 23, 2003). "Basic instinct may have saved Sharon Stone". USA Today. Retrieved June 3, 2008.
7.Management of acute severe traumatic brain injury. Author: Nicholas Phan, MD, FRCSC, FACS. UpToDate.com. Retrieved on 7/22/12