WBR0540
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| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | USMLE Step 1 |
| Main Category | Pathology |
| Sub Category | Neurology |
| Prompt | [[Prompt::A 74-year-old man is brought to the emergency department with a headache, decreased level of consciousness, and an altered mental state. Upon further questioning, the patient reports that he sustained a head trauma 2 weeks prior to presentation. His medical history is significant for coronary artery disease, type 2 diabetes mellitus, hypertension, and hyperlipidemia. A cranial CT scan demonstrates the findings in the image below. Which of the following causes best characterizes the patient's symptoms?
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| Answer A | Rupture of an arterial branch of the maxillary artery |
| Answer A Explanation | Epidural hematoma results from a rupture of the meningeal artery, a branch of the maxillary artery. It is often due to a traumatic injury to the temporal bone. Epidural hematoma is characterized by a "lucid interval", a time delay before clinical symptoms manifest. |
| Answer B | Rupture of a bridging vein |
| Answer B Explanation | Subdural hematoma is characterized by crescent-shaped hemoarrhage upon CT scan. |
| Answer C | Rutpure of a berry aneurysm |
| Answer C Explanation | Subarachnoid hemorrhage often results from a rupture of a berry aneurysm. Berry aneurysms are frequently associated with three pathologies: Marfan syndrome, Ehler-Danlos syndrome, and adult-dominant polycystic kidney disease (ADPKD). Clinically, patients with subarachnoid hemorrhage complain of a severe, sudden-onset headache. |
| Answer D | Reversible ischemia caused by arterial vasoconstriction |
| Answer D Explanation | Transient ischemic attack (TIA) is characterized by a reversible vasoconstrictive process, which may manifest as cerebral ischemia and symptoms of stroke that often self-resolve. Although TIA is a reversible condition, it is a serious disease because it often heralds a stroke. |
| Answer E | Decrease in the rate of cerebrospinal fluid (CSF) absorption |
| Answer E Explanation | Communicating hydrocephalus is characterized by a decrease in CSF absorption, causing a build-up of CSF within the ventricles, leading to an increased intracranial pressure (ICP) and papilledema. |
| Right Answer | B |
| Explanation | A subdural hematoma is characterized by the rupture of a bridging vein. Because the venous pressure system is a low-presure system as compared to the arterial system, the build-up of blood following subdural hematoma is slow and gradual increase in hematoma size develops over a prolonged period of time. On CT scan, subdural hematoma appears as a crescent-shaped hemorrhage that does not cross the falx cerebra but may cross the suture lines. Educational Objective: Upon CT scan, subdural hematoma, resulting from a rupture of bridging veins, appears as a crescent-shaped hemorrhage that crosses the suture lines but is unable to cross the falx cerebri. |
| Approved | Yes |
| Keyword | subdural hematoma, subarachnoid hemorrhage, subarachnoid hemorrhage, epidural hematoma, bridging veins, communicating hydrocephalus, aneurysm, headache, trauma, CT scan, TIA, transient ischemic attack, neurology, head trauma, rupture |
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