osmosis question bank hematoma (epidural ,subdural ;and sub arachnoid hemorrhage

Question 1

A 45 year-old woman comes to the
emergency department
because of a severe
headache
following a skiing accident. Immediately after the fall, she refused medical evaluation because she had no difficulty with
speech or movement and “felt fine.” Hours later she developed a severe headache and was taken to the hospital, but despite medical intervention she passed away. Which of the following is the most likely cause of this patient’s symptoms?

Answer 1

the right diagnosis is epidural hematoma caused by middle meningeal artery tear

why is that ,first of all, it is a trauma of ski ,severe ,$
there is presence of a lucid interval (the patient felt fine but after she developped symptoms )

–hours later ,means the acute development

we think of epi or extra dural hematoma which lead to HTIC which will eventially lead to herniation subtentorial which gonna lead to death !!!

this patient passed away unfourtunately but we could have done the CT scan without contrast which will show the convex lens hyperdense mass =dg + of épidural hematoma

Question 2

A 30 year-old woman comes to the 
emergency department
 because of a persistent severe 
headache
. While skiing today, she fell and hit the side of her head against a rock. She lost 
consciousness
 briefly and then got up. Her friends, worried about her progressive 
headache
, 
dizziness
, and 
nausea
, and told her that she should come and get checked out. Examination shows 
ipsilateral

pupil dilation
 and 
crepitus
 over the left 
temporal region
. The patient becomes increasingly 
lethargic
 throughout the examination. Which of the following investigations is the most appropriate in confirming the most likely diagnosis?

Answer 2

a CT scan without contrast

–if we suspect an intracranial hemorrhage by an accident or spontaneously , the highly sensitive examination is a CT scan without contrast ,

–in this case we have a epidural hematoma ,which lead to uncal herniation (herniation uncale va comprimer le nerf oculomoteur 3 )

Question 3

CI de la PL dans la suspicion d’hématomes intracraniens

Answer 3

Lumbar punctur is contraindicated if
increased intracranial pressure
is suspected, such as in
epidural hematomas ,because it can cause herniation of the brain through the foramen magnum compressing the brainstem and leading to respiratory arrest.