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 often 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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Subdural hematoma, WBRKeyword::Headache, WBRKeyword::Headaches |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |