WBR0540

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 74 year old male patient is brought to the emergency department with headache, decreased level of consciousness, and personality change. Upon further questioning, the patient reports he sustained a head trauma 2 weeks prior to presentation. His past medical history is significant for coronary artery disease (CAD), type 2 diabetes mellitus, hypertension, and hyperlipidemia. Head computed tomography (CT) scan is performed; it shows the findings seen in the image below. Which of the following characterizes the culprit of the patient's symptoms? ]]
Answer A	AnswerA::Rupture of an arterial branch of the maxillary artery
Answer A Explanation	[[AnswerAExp::Epidural hematoma is caused by the 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 further characterized by "lucid interval", which is defined as a time delay before which no clinical symptoms whatsoever are evident.]]
Answer B	AnswerB::Rupture of a bridging vein
Answer B Explanation	AnswerBExp::Subdural hematoma is characterized by crescent-shaped hemoarrhage on CT scan.
Answer C	AnswerC::Rutpure of a berry aneurysm
Answer C Explanation	[[AnswerCExp::Subarachnoid hemorrhage is often caused by a rupture of a berry aneurysm. Berry aneurysms are classically associated with 3 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 often described as "the worst headache of my life".]]
Answer D	AnswerD::Reversible ischemia caused by arterial vasoconstriction
Answer D Explanation	[[AnswerDExp::Transient ischemic attack (TIA) is characterized by reversible vasoconstrictive process that may cause cerebral ischemia and symptoms of stroke that often self-resolve. Although TIA is a reversible condition, it is still considered a serious disease because it often heralds a stroke. As such, patients must be closely monitored following a TIA for development of 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 that caused a build-up of CSF within the ventricles to cause an increased intracranial pressure (ICP) and papilledema.
Right Answer	RightAnswer::B
Explanation	[[Explanation::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: Subdural hematoma is caused by the rupture of bridging veins. It appears on CT scan as a crescent-shaped hemorrhage that crosses the suture lines but is unable to cross the falx cerebri. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::subdural, WBRKeyword::hematoma, WBRKeyword::subdural hematoma, WBRKeyword::subarachnoid, WBRKeyword::hemorrhage, WBRKeyword::subarachnoid hemorrhage, WBRKeyword::epidural, WBRKeyword::epidural hematoma, WBRKeyword::bridging, WBRKeyword::veins, WBRKeyword::bridging veins, WBRKeyword::vein, WBRKeyword::hydrocephalus, WBRKeyword::communicating, WBRKeyword::communicating hydrocephalus, WBRKeyword::aneurysm, WBRKeyword::headache, WBRKeyword::trauma, WBRKeyword::crescent, WBRKeyword::CT, WBRKeyword::scan, WBRKeyword::computed, WBRKeyword::tomography, WBRKeyword::TIA, WBRKeyword::transient, WBRKeyword::ischemic, WBRKeyword::attack, WBRKeyword::transient ischemic attack
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