MegaKleos
Full Member
- Joined
- Sep 19, 2018
- Messages
- 12
- Reaction score
- 1
To the mods/admins: In line with the SDN policy on NBME questions.. this question is not violating copyright of NBME as i have not posted any direct info.. its indirectly asking a question that was on NBME 7.. Hence please do not remove this post.. it falls under "fair use" of the copyright act.
A man is brought with features of: Severe Headache + Weakness on Lt side - 3 hrs after falling from a ladder and hit his head on the road below.
There was a brief period of unconsciousness but currently the patient is awake.
BP: 160/110
Rt pupil : Dilated
Lt Pupil : Normal
Lt Upper and lower extremity weakness
What would CT show:
1. Brain Stem Hemorrhage
2. Cerebeller Tonsil herniation
3. Cingullate gyrus herniation
4. Uncus herniation
5. SAH
The key says its an UNCUS herniation.. But i disagree..
In uncus herniation following features are seen:
- Ipsilateral 3rd CN palsy - Ipsilateral eye down & out + mydriasis + ptosis
- Ipsilateral PCA involvement - Contralateral Homonymous Hemianopia with Macular Sparing
- Duret Hemorrhage because of paramedian artery rupture in pons
- Contralateral Kernohan's notch impingement with contralateral crus cerebri involvement leading to ipsilateral spastic paralysis of the upper and lower limbs. --> This is the false localizing sign
So in uncal herniation causes : ipsilateral pupillary dilation + ipsilateral UMN paralysis..
But the question says contralateral paralysis and hence i believe it should be Brainstem hemorrhage..
Please pitch in.. Thanks..
A man is brought with features of: Severe Headache + Weakness on Lt side - 3 hrs after falling from a ladder and hit his head on the road below.
There was a brief period of unconsciousness but currently the patient is awake.
BP: 160/110
Rt pupil : Dilated
Lt Pupil : Normal
Lt Upper and lower extremity weakness
What would CT show:
1. Brain Stem Hemorrhage
2. Cerebeller Tonsil herniation
3. Cingullate gyrus herniation
4. Uncus herniation
5. SAH
The key says its an UNCUS herniation.. But i disagree..
In uncus herniation following features are seen:
- Ipsilateral 3rd CN palsy - Ipsilateral eye down & out + mydriasis + ptosis
- Ipsilateral PCA involvement - Contralateral Homonymous Hemianopia with Macular Sparing
- Duret Hemorrhage because of paramedian artery rupture in pons
- Contralateral Kernohan's notch impingement with contralateral crus cerebri involvement leading to ipsilateral spastic paralysis of the upper and lower limbs. --> This is the false localizing sign
So in uncal herniation causes : ipsilateral pupillary dilation + ipsilateral UMN paralysis..
But the question says contralateral paralysis and hence i believe it should be Brainstem hemorrhage..
Please pitch in.. Thanks..