Anatomy Gone Wrong
A patient with an epidural hematoma compressing the temporal lobe might show which cranial nerve palsy (dilated pupil) due to compression near the tentorium?
CN III palsy (oculomotor nerve)
What chronic condition is the single greatest risk factor for spontaneous intracerebral hemorrhage?
Chronic hypertension
What imaging modality is the first line for suspected intracranial hemorrhage?
Non-contrast CT
For an epidural hematoma, what is the emergent surgical treatment?
Emergent craniotomy/evacuation
What is herniation, in basic terms, and why is it dangerous?
Displacement of brain tissue compressing vital structures
A cerebellar hemorrhage in the posterior fossa compresses the fourth ventricle. What effect does this have on CSF flow and which neurological sign would you expect?
Obstructs CSF → hydrocephalus; vomiting, decreased consciousness
What vascular abnormality is commonly involved in lobar hemorrhages in older adults?
Cerebral amyloid angiopathy
On non-contrast CT: what shape is classical for an epidural hematoma vs a subdural hematoma?
Epidural = lens/biconvex; Subdural = crescent
In spontaneous intracerebral hemorrhage, what is the goal systolic blood pressure you aim for in acute management?
~140 mmHg
In patients with high spinal cord injuries, what dangerous condition can be triggered by bladder distension or other stimuli below the level of injury?
Autonomic dysreflexia — uncontrolled sympathetic discharge causing severe hypertension, bradycardia, headache
Complete loss of motor and sensory below the level of injury indicates what type of spinal cord lesion?
Complete spinal cord transection
What type of cervical spine injury commonly occurs in head-on collisions, often damaging the anterior spinal cord?
Hyperflexion injury → anterior cord syndrome
If a subarachnoid hemorrhage is strongly suspected but CT is negative, what is the next diagnostic step?
Lumbar puncture for xanthochromia
What factors determine if a cerebellar hemorrhage should be evacuated surgically?
>3 cm, brainstem compression, hydrocephalus, deterioration
What is rebleeding risk after aneurysmal subarachnoid hemorrhage, and how soon is it highest?
Highest risk in first 24 hours
If an intracerebral hemorrhage involves the thalamus, how might that present differently (sensory, consciousness, etc.) vs a lobar cortical hemorrhage?
Sensory loss, consciousness changes vs aphasia, seizures
What is the pathophysiologic process in chronic subdural hematoma formation, especially in elderly patients?
Tearing of bridging veins → slow venous bleed
What imaging modality is best for evaluating soft tissue and cord injury in suspected spinal cord injury?
MRI
Which controversial therapy was historically used within 8 hours of SCI to reduce secondary injury, but is no longer routinely recommended?
High-dose methylprednisolone
How does neurogenic shock differ from hypovolemic shock?
Neurogenic shock = hypotension + bradycardia
Hypovolemic = hypotension + tachycardia
Loss of motor function and vibration sense on the same side, but loss of pain/temperature on the opposite side below the lesion = which spinal cord syndrome?
Brown-Séquard syndrome
A fall onto the face in an elderly patient often causes central cord syndrome. What deficits are seen?
Greater weakness in upper limbs > lower limbs; bladder dysfunction; variable sensory loss
A patient with a traumatic spinal cord injury has loss of motor function below the lesion, but pain and temperature sensation are preserved. Which syndrome does this represent?
Anterior Cord Syndrome
What is the immediate prehospital management for suspected spinal cord injury?
Airway protection and spinal immobilization
Explain how delayed care changes outcomes, with specific examples of what worsens
Delayed imaging/surgery = prolonged ↑ICP, higher mortality, worse deficits