WBR0289

Author	[[PageAuthor::Ogheneochuko Ajari, MB.BS, MS [1] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 38-year-old male presents to the emergency room with complaints of a headache, difficulty maintaining balance, and progressive memory loss. Three weeks prior to presentation, he was involved in a motor vehicle accident. During examination the man appears alert and oriented to his identity, but not to the current location or date. A CT scan of the head demonstrates a crescent-shaped hemorrhage crossing the suture lines. A rupture in which of the following structures is the most likely cause of this patient’s symptoms?]]
Answer A	AnswerA::Rupture of the middle meningeal artery
Answer A Explanation	[[AnswerAExp::Rupture of the middle meningeal artery occurs with epidural hematoma]]
Answer B	AnswerB::Rupture of an aneurysm
Answer B Explanation	[[AnswerBExp::Rupture of an aneurysm occurs in subarachnoid hemorrhage, which may occur as a complication of Marfan’s syndrome, Ehlers-Danlos syndrome, adult polycystic kidney disease, or arteriovenous malformation.]]
Answer C	AnswerC::Rupture of bridging veins
Answer C Explanation	AnswerCExp::See explanation
Answer D	AnswerD::Rupture of the anterior communicating artery
Answer D Explanation	[[AnswerDExp::Rupture of the anterior communicating artery typically causes visual field defects in patients.]]
Answer E	AnswerE::Rupture of the posterior communicating artery
Answer E Explanation	[[AnswerEExp::Rupture of the posterior communicating artery typically causes CN III palsy in patients.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient in this scenario presents with symptoms suggestive of subdural hematoma, which occurs as a result of the rupture of the bridging veins. It is ofetn observed in elderly individuals, alcoholics, blunt trauma patients, and individuals suffering from shaken baby syndrome. A CT scan of the head would demonstrate a crescent-shaped hemorrhage crossing the suture lines. The gyri would be preserved because pressure is equally distributed due to the relatively gradual accumulation of blood. Educational Objective Subdural hematoma results from the rupture of the bridging veins. Reference: First AID for the USMLE Step 1 2011 Pgs 405-406 Educational Objective: References: ]]
Approved	Approved::Yes
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