Ch. 5 - Traumatic intracranial hematomas Flashcards Preview

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Flashcards in Ch. 5 - Traumatic intracranial hematomas Deck (36)
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1

Most common site of extradural hematoma?

Temporal region > frontal; uncommonly posterior fossa and parasagittal

2

Vessel most likely torn in extradural hematoma

Middle meningeal artery

Uncommonly extradural veins, superior sagittal sinus, transverse sinus, posterior meningeal

3

How often does a fracture overly an extradural hematoma?

95% of adults; 75% of children

4

Population most likely to have extradural hematoma

Children and adults <20 years because dura strips off more readily

5

Extradural hematoma presentation

Severe head injury followed by deterioration of neurological state (esp. CN3 palsy and hemiparesis), HA, possibly transient LOC, Cushing's reflex

6

Most important neurological sign of extradural hematoma

Deteriorating conscious state after lucid interval

7

CT appearance of extradural hematoma

Hyperdense biconvex hematoma with compression of underlying brain and distortion of lateral ventricle

8

Tx of extradural hematoma

Craniotomy and evacuation, mannitol or furosemide infusion, hyperventilation

9

Burr hole locations for extradural hematoma tx

Temporal first, then frontal and parietal

10

If extradural hematoma location is unknown, which side do you burr hole

Side of fracture

Underlying boggy swelling of skull

Same side as dilated pupil if present

85% of cases on contralateral side of hemiparesis

11

Why open dura during extradural hematoma evacuation?

To exclude coexisting subdural hematoma

12

Prognosis of extradural hematoma

Potentially reversible, full recovery expected if evacuated early enough

13

Define 3 types of subdural hematomas

Acute - less than 3 days

Subacute - 4-21 days

Chronic - 21+ days

13

Causes of acute subdural hematoma

Severe trauma and cortical lacerations OR

Less severe trauma and rupture of bridging veins (esp. if anticoagulated or cortical atrophy)

14

Appearance of subdural hematoma on CT

Concave towards brain:

Acute - hyperdense

Subacute - isodense with adjacent brain

Chronic- hypodense

15

How often are acute subdural hematomas bilateral?

1/3 of cases

16

Presentation of acute subdural hematoma

Severe head injury with deteriorating neuro state or failure to improve

17

Commonly associated fracture with acute subdural hematoma

80% have fracture of cranial vault or base of skull

18

Treatment of acute subdural hematoma

Craniotomy to evacuate

19

Two major groups of chronic subdural hematomas

Severe head injury OR

No history of head trauma (1/3 of cases) - 2/2 rupture of bridging veins in cortical atrophy

20

Presentation of chronic subdural hematoma

1. Deterioration after head injury

2. Increased ICP without localizing signs

3. Fluctuating drowsiness

4. Progressive dementia (more rapid than Alzheimer's) with possible focal neurological signs esp. hemiparesis

21

How often are chronic subdural hematomas bilateral?

25% of cases

22

Tx of chronic subdural hematomas

Burr holes vs. craniotomy but do not attempt to excise hematoma membrane (may be multiloculated)

23

Post-op management of chronic subdural hematoma evacuation

Lie patient flat + adequate hydration to encourage brain to swell and expand into hematoma space (watch for hyponatremia)

24

Causes of chronic subdural hematoma in infancy

Birth trauma, abuse (10% of battered children)

25

How often are subdural hematomas bilateral in infants?

85% of cases

26

Earliest finding of chronic subdural hematoma in infants

Excessive cranial enlargement; nonspecific findings (failure to thrive, irritability)

27

Tx of chronic subdural hematoma in infant

Aspirate fluid; shunt if repeated aspirations unsuccessful

28

Causes of intracerebral hematoma

Penetrating injury, depressed skull fracture, severe head trauma

29

What other type of hemorrhage is commonly associated with subdural hematoma?

Intracerebral hemorrhage