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51 Cards in this Set
- Front
- Back
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The orbital foramina contains which cranial nerves?
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II, III, V, VI
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Where does a diverticulum have to be a Zenker's Diverticulum?
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above the Cricopharyngeus muscle
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What does epiglottitis look like on lateral x-ray?
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thumb sign
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What views are included in a complete C-spine series?
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AP, lateral, odontoid, oblique, flexion/extension
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Spinal cord hemorrhage or contusions are best seen with what imaging study?
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MRI
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What are the 4 steps of the Nexus study?
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1. midline pain or bony tenderness, crepitus, or step-off
2. neurologic deficit (including complaints of paresthesia or numbness) 3. presence of distracting injuries 4. altered mental status (including intoxication) |
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Describe the Canadian C-Spine rules
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• 1st question - any high-risk factor that mandate radiography (such as age > 65, dangerous mechanism, or paresthesias in extremities); if yes » Xray, if no » go to 2nd question
• 2nd question - any low-risk factor that allows safe assessment of range of motion (simple rear-end MVC, sitting positio in the ER, ambulatory at any time, delayed onset of neck pain, or absence of midline c-spine tenderness); if no » Xray, if yes » go to 3rd question • 3rd question - able to rotate neck actively; if unable to rotate » Xray, if yes » no Xray |
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Name 3 major C-spine fractures
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• Hangman's fracture
• Jefferson fracture • Extension "teardrop" fracture |
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Describe a Hangman's fracture
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an unstable fracture of the pedicles of the posterior arch of C2 caused by extension and distraction injury
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Describe a Jefferson fracture
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• an axial load compression fracture of the anterior and posterior arches of C1
• an unstable fracture • lateral masses of C1 lying lateral to the lateral masses of C2 (results as a spread of the ring of C1) |
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Describe a extension "teardrop" fracture
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an unstable fracture where the anterior longitudinal ligament avulses the anterior-inferior corner of the vertebral body
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What are the 3 classifications of odontoid fractures?
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• Type 1 - a piece of the odontoid is fractured
• Type 2 - a fracture at the base of the odontoid • Type 3 - a fracture including part of the vertebral body |
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Ultrasound is used to evaluate what structures in the neck?
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• thyroid
• carotid artery (for stenosis) • jugular vein |
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Angiography are still used for which interventional procedures?
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• for visualizing vascular stenosis (being replaced by CT/MRI)
• carotid stents • coils in aneurysms • stopping hemorrhage (persistent nose bleeds) • embolizing tumors • treating vascular malformations |
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What is an AVM?
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arteriovenous malformation
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When should you use a head CT?
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• acute bleed
• trauma • stroke • fractures of the head and face |
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Which imaging study is generally the best choice for soft tissue detail of the brain?
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CT scan
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What are some secondary injuries caused by coup/countercoup?
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• intercranial hemorrhage
• cerebral edema • mass lesions • increased intracranial pressure |
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What is a concussion?
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• a diffuse head injury
• usually assoiciated with transient loss of consciousness that occurs immediately following blunt head trauma • amnesia and confusion are clincal hallmarks |
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What is the Glasgow Coma Scale (GCS)?
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• a numeric rating of the eye, verbal, and motor response
• used to classify traumatic brain injury • only useful in non-intubated and non-sedated patient |
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Describe the rating of the GCS for eye opening
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• 4 - spontaneous
• 3 - to speech • 2 - to pain • 1 - no response |
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Describe the rating for GCS for verbal response
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• 5 - alert and oriented
• 4 - disoriented conversation • 3 - speaking but nonsensical • 2 - moans or unintelligible sounds • 1 - no response |
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Describe the rating of the GCS for motor response
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• 6 - follows commands
• 5 - localized pain • 4 - movement or withdrawal to pain • 3 - decortiate flexion • 2 - decerebrate extension • 1 - no response |
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What is the GCS for mild brain injury? moderate brain injury? severe brain injury?
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• Mild: GCS 13-15
• Moderate: GCS 9-12 • Severe: GCS 3-8 |
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What is the most common neuroimaging tool used in the emergency department?
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non-contrast head CT
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What are some benefits of a Non-contrast Head CT?
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• gold standard in assessment for acute hemorrhage
• very good at documenting mass effect and herniation • will visualize acute ischemia, neoplasm, localized intracranial infection • good at visualizing skull fracture |
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What are drawbacks of Non-contrast Head CT?
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• poor at visualizing disease in the posterior cranial fossa, especially ischemia
• poor at diagnosing intracranial mass that does not have significant mass effect • sensitivity is not high enough to completely eliminate sub-arachnoid hemorrhage • will miss delayed disease (delayed sub-arachnoid hemorrhage) |
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Epidural hematoma is assoicated with skull fracture and laceration of which artery?
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dural artery (middle meningeal artery)
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How do patients with epidural hematoma present?
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• presents with brief loss of consciousness
• followed by lucid interval of minutes to hours • then rapid neurological decline into coma |
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How does an epidural hematoma look like on CT?
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• biconvex hematoma (lens shaped)
• does not cross suture lines • frequently associated with mass effect |
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What vessels are injured in a patient with a subdural hematoma?
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bridging veins or cortical arterioles
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How does a subdural hematoma look like on CT?
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• crescent shaped hematoma lying between brain and dura, conforming to brain surface
• can cross suture lines (usually spreads more extensively than epidural) |
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If suspicion for a subarachnoid hemorrhage is high, but the CT is negative, what additional test should be done?
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lumbar puncture
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What is Xanthochromia?
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breakdown of RBCs in the CSF
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What are some sources of subarachnoid hemorrhage?
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• post-traumatic
• aneurysmal • arteriovenous malformation (AVM) |
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What can diffuse or focally increased intercranial pressure (ICP) cause?
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herniation of the brain at several locations
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What is transtentorial (uncal) herniation?
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• occurs when the uncus of the temporal lobe is forced through the tentorial hiatus
• causes compression of the ipsilateral third cranial nerve and the cerebral peduncle |
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How does a patient with transtentorial (uncal) herniation present?
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dilated ipsilateral pupil and contralateral hemiparesis
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Where can intracerebral hemorrhages occur?
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anywhere in the parenchyma
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What are characteristics of Diffuse Axonal Injury (DAI)?
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• aka shear injury or brain stem contusion
• microscopic tearing of nerve fibers due to high acceleration/deceleration injury • radiographically consists of small petechial hemorrhages in white matter tracts • causes immediate deep coma • associated with severe cerebral edema and ICP elevation |
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What are some causes of a ring enhancing lesion?
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• Toxoplasmosis (in HIV+ patients)
• Lymphoma |
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Why should patients with cerebral contusions have a repeat head CT within 24 hours?
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contusions frequently evolve from small petechiae to large areas of edema and hemorrhage
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What type of stroke is more common?
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• ischemic is more common (~75%)
• hemorrhagic occurs 25% |
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Name 4 subtypes of ischemic strokes
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• Thrombotic - a blood clot forms within a blood vessel in the brain
• Embolic - a blood clot forms within the heart or a major blood vessel and lodges in the brain • Lacunar - a very small blood vessel of the brain progressively narrows until completely occluded • Cryptogenic - mechanism for the stroke is unknown |
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What does ischemia on CT look like?
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darker area
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What is the difference between a focal and diffused contusion/hemorrhage?
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• focal lesions produce dysfunction specific to the inkjured area of the brain
• diffuse injuries are associated with global dysfunction (LOC, cognitive and memory problems) |
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When is an MRI the best test to use?
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• brain tumors, strokes, certain cronic disorders of the nervous system (multiple sclerosis)
• patients with dementia and patients with disease of the pituitary gland • to detect tiny areas of tissue abnormality in patients with disease of the eyes or inner ear |
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What radiology study is used to view the temporal bone?
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CT because very fine bone detail is important
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What imaging study is best to view the sinuses?
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mostly CT, coronal plane is very helpful
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What imaging study is best to view the temporomandibular joint (TMJ)?
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mostly MRI
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What imaging study is best to view the orbits?
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• CT (for acute problems) or MRI (for chronic) used about equally
• some Opthalmologists use ultrasound |
