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Surgery Nervous System 105102cb

Lucid interval is classically seen in-

A
Extradural hematoma
B
Acute subdural hematoma
C
Chronic subdural hematoma
D
Intraventricular hemorrhage
High-Yield Explanation
Ans. is 'a' i.e., Extradural hematoma Clinical and radiographic characteristics of the main traumatic brain lesions Epidural (extradural) hematomaAcute Subdural hematomaChronic subdural hematomaContusion/ Parenchymal HemorrhageSubarachnoid hemorrhageCausative factorLaceration of middle cerebral artery or dural sinusTearing of bridging pial veins and arteriesTrauma (may be absent or minimal)Risk factors: coagulopathy and severe brain atrophyShearing of parenchymal vessels.Rusk factors: coagulopathy and amyloid vasculopathyExclude underlying aneurysmal ruptureTypical locationLateral cerebral convexitiesLateral cerebral convexitiesLateral cerebral convexitiesInferior frontal and temporal lobes may be bilateralBasilar cisternsEvolutionHoursMany hoursDays to weeksExpand over 12-48 hoursMinutes to hoursClinical profileClassically, lucid interval then coma, but more variablePupillary dilation with contralateral then bilateral limb weakness, slowly evolving stupor then comaDrowsiness, Coma, pupillary dilation with contralateral then bilateral limb weakness, progressive stupor then comaHeadache, progressive alteration in mentral status +- focal neurologic signsStupor - coma, dilated pupil, progressive hemiplegia, spasticityHeadache, meningismus delayed manifestations, vasospasmAge at riskRadiologic featuresChildern, young adultsAcute bulging epidural clot bounded by cranial sutures; lenticular in shapeAnyAcute blood rimming broad region of cerebral convexity, crescentic shapeElderlyHyper-or isodense, unilateral or bilateral, crescentic shapeAnyMuliple, confluent regions of edema intermixed with focal, acute bloodAnyAcute blood lining cortex in subarachnoid spaceSurgical interventionUrgent evacuationUrgent evacuation if large enough to cause symptomsEvacuation in some circumstancesEvacuate if largeGenerally not treated may cause secondary vasospasm

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