CNS question

[jackets5]

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I just wanted to get an opinion on a question that was asked today that i disagreed with the professor today.

60 y/o man is shoveling snow when he slips and falls. He gets up goes inside and feels okay 2 hours later he is having coffee with his wife when he starts feeling disoriented and had a severe headache. At the ER x-ray shows skull fracture. What is the diagnosis?

 

[SomeDoc]

I just wanted to get an opinion on a question that was asked today that i disagreed with the professor today.

60 y/o man is shoveling snow when he slips and falls. He gets up goes inside and feels okay 2 hours later he is having coffee with his wife when he starts feeling disoriented and had a severe headache. At the ER x-ray shows skull fracture. What is the diagnosis?

Epidural hematoma.
Typically this is due to damage to the middle meningeal artery w/ concurrent fracture of the cranium.

However, subdural hematoma could also be possible due to the rapid deceleration (cerebral vein rupture), but is less likely given the partial xray findings.

 

[ChiDO]

Epidural hematoma.
Typically this is due to damage to the middle meningeal artery w/ concurrent fracture of the cranium.

However, subdural hematoma could also be possible due to the rapid deceleration (cerebral vein rupture), but is less likely given the partial xray findings.

Agree --> Epidural hematoma.

Although, from the question, it seems like you would have to be given more info, such as a CT scan, to conclude this.

 

[danzman]

Epidural hematoma with lucid interval. Skull fracture seals the deal...

Have you been watching the news lately?

 

[jackets5]

Epidural hematoma.
Typically this is due to damage to the middle meningeal artery w/ concurrent fracture of the cranium.

However, subdural hematoma could also be possible due to the rapid deceleration (cerebral vein rupture), but is less likely given the partial xray findings.

I said Epidural hematoma because of the X-ray findings of skull fracture. Professor said the answer was subdural because of the patients age and was talking about brain atrophy as you age so more room for the brain to move and rupture the bridging veins. But come on isnt a skull fracture after trauma classical presentation for a Epidural hematoma. He said you can have skull fracture with subdural but i went home and looked it up and really cant find anything having to do with skull fracture in subdural on accel-decel injuries.

 

[SomeDoc]

I said Epidural hematoma because of the X-ray findings of skull fracture. Professor said the answer was subdural because of the patients age and was talking about brain atrophy as you age so more room for the brain to move and rupture the bridging veins. But come on isnt a skull fracture after trauma classical presentation for a Epidural hematoma. He said you can have skull fracture with subdural but i went home and looked it up and really cant find anything having to do with skull fracture in subdural on accel-decel injuries.

The professor should have provided additional information (ie. CT scan showed biconvex hematoma which does not cross suture lines vs. lenticular hematoma which crosses suture lines). Unfortunately, this is one of those questions that can have multiple answers, due to insufficient information.

 

[danzman]

I said Epidural hematoma because of the X-ray findings of skull fracture. Professor said the answer was subdural because of the patients age and was talking about brain atrophy as you age so more room for the brain to move and rupture the bridging veins. But come on isnt a skull fracture after trauma classical presentation for a Epidural hematoma. He said you can have skull fracture with subdural but i went home and looked it up and really cant find anything having to do with skull fracture in subdural on accel-decel injuries.

Crummy question. Of course you can have a skull fracture with either. The sub is more common I think, but the lucid interval was only two hours. With a subdural after a short fall, you would have a longer interval (days), unless it was a direct hit on a rock or something. The age part of the question was the only indicator of the vascular atrophy, and 60 aint that old. Can't really tell without the CT though...

 

[jackets5]

The professor should have provided additional information (ie. CT scan showed biconvex hematoma which does not cross suture lines vs. lenticular hematoma which crosses suture lines). Unfortunately, this is one of those questions that can have multiple answers, due to insufficient information.

exactly you need more information, that is how all of our questions are on exams. they lack information and your left trying to pick from 2 correct answers that you need more information to make the determination. Im sorry i see skull fracture w/ lucid interval and think Epidural this ***** of a professor says subdural because of the pts age. Like old people somehow cant get epidural hematoma's

 

[MediumDef]

Wouldn't a lucid interval normally imply there was a non-lucid state preceding it. This just says slip and fall gets up feeling fine. While I agree that it's not the most impressively phrased Q neither is it a slam dunk the other way. Unless you can find evidence that the most common TBI found in an elderly person who suffers a skull fracture is an epidural I think you're hosed.

Unfortunately as we have all learned the getting the correct answer is about 50% knowledge 25% guesswork and 25% reading professors mind

 

[TexasPhysician]

The question is unanswerable without a CT image. It could easily be either without one.

 

[Dirt]

The question is unanswerable without a CT image. It could easily be either without one.

Or just a skull fracture with a concussion. Headache and disorientation don't necessarily mean bleed.

 

[coffeebythelake]

Where is the skull fracture? I think that's important too.

 

[TexasTriathlete]

Caffeine toxicity. He was drinking a cup of coffee. The rest is just there to throw you off.

 

[Eudjinn]

The question is unanswerable without a CT image. It could easily be either without one.

/agree

need a CT and more of the patient's history (alcoholic?)

 

[bodonid]

classic talk & die syndrome. MMA epidural.

 

[Depakote]

Munchausen's by proxy.

The wife clearly iced the driveway in the hopes that her husband would fall and be injured so she would be able to receive attention or other benefits.

 

[ClockworkDoc]

I'm saying MS, Guillain-Berre, or his wife is a battle axe.

 

[heysexylady]

I just wanted to get an opinion on a question that was asked today that i disagreed with the professor today.

60 y/o man is shoveling snow when he slips and falls. He gets up goes inside and feels okay 2 hours later he is having coffee with his wife when he starts feeling disoriented and had a severe headache. At the ER x-ray shows skull fracture. What is the diagnosis?

1. its a epidural hematoma.....2 hours...talk and die situation

2. people are ridiculous for stating that it could be a subdural hematoma....it takes 4-6 weeks for symptoms to actually show since the bridge veins are low pressure system.

This is a gimme question...you don't even need a ct/mri scan to get this question.