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  #1  
Old 11-11-2011
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Neuro Head Trauma and Hemiparesis

A 75 years-old woman is brought to the Emergency Department semicomatose 24 hrs after hitting the the back of her head in a fall. No symptoms were present after the fall but she developed blurred vision and weakness of the left extremities 18 hrs after the fall. Examination shows left hemiparesis and right pupil is dilated and unresponsive to light. A CT scan without contrast shows a diffuse extra-axial hemorrhage over the right cerebral hemisphere. Which of the following is the most likely mechanism of injury?
a- contusion of the brain
b- laceration of a cerebral bridging vein
c- laceration of a small leptomeningeal blood vessel
d- laceration of the middle meningeal artery
e- shearing forces damaging white matter
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  #2  
Old 11-11-2011
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d-laceration of middle meningeal artery
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  #3  
Old 11-11-2011
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i think its a subdural heammorhgae and so laceration of bridging veins
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  #4  
Old 11-11-2011
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Bbbbbbbbbbbbbbbbbbbbbbb:d:d:d
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Old 11-11-2011
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I think it's important in this situation to differentiate between choices B & C "other choices can be excluded by there irrelevance either to trauma hx, manifestations or imaging findings".... so:

Quote:
No symptoms were present after the fall but she developed blurred vision and weakness of the left extremities 18 hrs after the fall
this is the "lucid interval"
it can be seen in both subdural hemorrhage SDH & epidural EDH
but it's more common in EDH
it's more prolonged in SDH

Quote:
left hemiparesis
non-specific finding in any type of pathology affecting the right cerebral hemisphere cortex

Quote:
right pupil is dilated and unresponsive
also a non-specific finding of increased ICP with uncal herniation & compression of brain stem "III CN"

Quote:
CT scan without contrast
the diagnosis of choice in such situation

Quote:
diffuse extra-axial hemorrhage
this is more consistent with SDH than EDH

EDH >> arterial source of bleeding "MMA" >> X
SDH >> mostly venous source of bleeding "bridging vv." >> B
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The above post was thanked by:
excellence (09-13-2014), menatallah Elgohary (11-15-2011), scopusmount (11-14-2011)



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Nervous-System-, Neuroanatomy-, Pathology-, Step-1-Questions

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