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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{ | |QuestionAuthor= {{YD}} {{Alison}} (Reviewed by Serge Korjian) | ||
|ExamType=USMLE Step 1 | |ExamType=USMLE Step 1 | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
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|MainCategory=Pathology | |MainCategory=Pathology | ||
|SubCategory=Neurology | |SubCategory=Neurology | ||
|MainCategory=Pathology | |||
|MainCategory=Pathology | |MainCategory=Pathology | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
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|MainCategory=Pathology | |MainCategory=Pathology | ||
|SubCategory=Neurology | |SubCategory=Neurology | ||
|Prompt=A 74 year old | |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? | ||
[[Image:WBR subdural hematoma.png|250px]] | [[Image:WBR subdural hematoma.png|250px]] | ||
|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. | |||
|AnswerA=Rupture of an arterial branch of the maxillary artery | |AnswerA=Rupture of an arterial branch of the maxillary artery | ||
|AnswerAExp=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. | |||
|AnswerB=Rupture of a bridging vein | |AnswerB=Rupture of a bridging vein | ||
|AnswerBExp=Subdural hematoma is characterized by crescent-shaped hemoarrhage upon CT scan. | |||
|AnswerC=Rutpure of a berry aneurysm | |AnswerC=Rutpure of a berry aneurysm | ||
|AnswerCExp=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. | |||
|AnswerD=Reversible ischemia caused by arterial vasoconstriction | |AnswerD=Reversible ischemia caused by arterial vasoconstriction | ||
|AnswerDExp=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. | |||
|AnswerE=Decrease in the rate of cerebrospinal fluid (CSF) absorption | |AnswerE=Decrease in the rate of cerebrospinal fluid (CSF) absorption | ||
|AnswerEExp=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. | |||
|EducationalObjectives=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. | |||
|References=First Aid 2014 page 462 | |||
|RightAnswer=B | |RightAnswer=B | ||
|Approved= | |WBRKeyword=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 | ||
|Approved=Yes | |||
}} | }} |
Latest revision as of 00:54, 28 October 2020
Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]] |
---|---|
Exam Type | ExamType::USMLE Step 1 |
Main Category | MainCategory::Pathology |
Sub Category | SubCategory::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? |
Answer A | AnswerA::Rupture of an arterial branch of the maxillary artery |
Answer A Explanation | [[AnswerAExp::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 | AnswerB::Rupture of a bridging vein |
Answer B Explanation | AnswerBExp::Subdural hematoma is characterized by crescent-shaped hemoarrhage upon CT scan. |
Answer C | AnswerC::Rutpure of a berry aneurysm |
Answer C Explanation | [[AnswerCExp::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 | AnswerD::Reversible ischemia caused by arterial vasoconstriction |
Answer D Explanation | [[AnswerDExp::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 | AnswerE::Decrease in the rate of cerebrospinal fluid (CSF) absorption |
Answer E Explanation | AnswerEExp::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 | RightAnswer::B |
Explanation | [[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 | Approved::Yes |
Keyword | WBRKeyword::subdural hematoma, WBRKeyword::subarachnoid hemorrhage, WBRKeyword::subarachnoid hemorrhage, WBRKeyword::epidural hematoma, WBRKeyword::bridging veins, WBRKeyword::communicating hydrocephalus, WBRKeyword::aneurysm, WBRKeyword::headache, WBRKeyword::trauma, WBRKeyword::CT scan, WBRKeyword::TIA, WBRKeyword::transient ischemic attack, WBRKeyword::neurology, WBRKeyword::head trauma, WBRKeyword::rupture |
Linked Question | Linked:: |
Order in Linked Questions | LinkedOrder:: |