Neuro

Question 1

List the 6 layers/spaces of the skull from outside to inside

Answer 1

• Skull
• Dura mater
• Arachnoid mater
  – Subarachnoid space
• Pia mater
• Brain parenchyma

Question 2

Between what layers do Epidural bleeds occur?

Answer 2

Skull and Dura mater

Question 3

What is unique about Epidural bleeds?

Answer 3

They do NOT cross suture lines

Question 4

How do Epidural bleeds arise?

Answer 4

Temporal bone fracture that lacerates the middle meningeal artery

Question 5

Describe the patient presentation with an Epidural bleed

Answer 5

1. Loss of consciousness
2. Lucid (normal) interval
3. Rapid DETERIORATION

Question 6

What is the imaging choice for brain bleeds/trauma?

Answer 6

CT with NO CONTRAST

Question 7

What is the imaging choice for brain bleeds/trauma? Contrast type?

Answer 7

CT with NO CONTRAST

Question 8

How will an Epidural bleed look on CT?

Answer 8

Lens shaped – more spherical

Question 9

Between what layers do Subdural bleeds occur?

Answer 9

Dura and Arachnoid mater

Question 10

How do Subdural bleeds often occur?

Answer 10

Tearing of the bridging veins

Question 11

In what patients are Subdural bleeds more common?

Answer 11

Older patients/alcoholics with atrophic brains

Question 12

How will a Subdural bleed present?

Answer 12

Gradually worsening focal neuro deficit/altered mental status

Question 13

How will a Subdural bleed look on CT?

Answer 13

Crescent shaped

Question 14

What is the treatment for Epidural and Subdural bleeds?

Answer 14

Craniotomy/Craniectomy

Question 15

Between what layers do Subarachnoid bleeds occur?

Answer 15

Arachnoid mater and Pia mater
– IN the Subarachnoid space

Question 16

What is the most common cause of a Subarachnoid bleed?

Answer 16

Aneurysm

Question 17

How will a patient present with a Subarachnoid bleed?

Answer 17

“Thunderclap headache”
– Sudden onset to maximum intensity very FAST
+/- signs of meningitis

Question 18

How will a Subarachnoid bleed look on CT?

Answer 18

Bright white blood lining the gyri/sulci and basal cistern

Question 19

Will there be surrounding gray (vasogenic edema) with a Subarachnoid bleed?

Answer 19

NO

Question 20

If a Subarachnoid bleed is confirmed on CT, what test should be done next?

Answer 20

CTA to find the aneurysm

Question 21

If a CT is (-) but you are concerned for a Subarachnoid bleed, what test should be done next?

Answer 21

Lumbar puncture

Question 22

What often causes an Intraparenchymal Hematoma?

Answer 22

HTN related bleed in the lenticulostriate arteries

Question 23

How will the patient present with an Intraparenchymal Hematoma?

Answer 23

Focal neuro deficit that looks like a stroke

Question 24

How will an Intraparenchymal Hematoma look on CT?

Answer 24

Bright white blood in the brain that IS surrounded by dark gray (vasogenic edema)

Question 25

Will there be surrounding gray (vasogenic edema) with Intraparenchymal Hematomas?

Answer 25

YES

Question 26

Where are Basilar Skull fractures?

Answer 26

Base of skull or floor of face

Question 27

What are 3 signs of a Basilar skull fracture?

Answer 27

Battle sign (bruise behind ears) Raccoon eyes (bruise around eyes) CSF leaking from nose/ears

Question 28

What imaging (2) should be done when concerned for a Basilar skull fracture?

Answer 28

CT of the maxillary/facial region CTA

Question 29

What defines a concussion/TBI?

Answer 29

Trauma that results in change in neurologic function

Question 30

How do concussions usually present?

Answer 30

Loss of consciousness +/- amnesia

Question 31

How will the CT look with a concussion?

Answer 31

Normal -- rules out bleed

Question 32

Treatment for concussion?

Answer 32

Discharge and individual treatment plan

Question 33

If you see punctate hemorrhages on the front/back of the brain, what is that called?

Answer 33

Intraparenchymal contusions

Question 34

What causes Diffuse Axonal Injury?

Answer 34

Deceleration injury that shears the axons

Question 35

How will the CT look with a Diffuse Axonal Injury?

Answer 35

Normal at first

Question 36

The CT may be normal at first with a Diffuse Axonal Injury, however the patient will be?

Answer 36

Comatose usually

Question 37

After a few days following a Diffuse Axonal Injury, what imaging should be done?

Answer 37

MRI

Question 38

What is important to consider when medically treating Subarachnoid/Intraparenchymal bleeds?

Answer 38

Keep the BP LOW to prevent rebleeds/worsening of the bleed