neurosurgery is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...

1. - DR.AKIF A.B

2. - Site = between skull and outer layer of Dura

3. -Source of bleed = Middle meningeal Vessels mostly Artery
- Mostly associated with skull fracture
- Presentation: Injury – Lucid Interval – unconsciousness
- Most common site : Temporo-Parietal Region
- Lucid interval is a temporary improvement in a patient's condition after a
traumatic brain injury, after which the condition deteriorates.
A lucid interval is especially indicative of an epidural hematoma.

4. Lens/Biconvex shaped hyperdense lesion is seen between brain and skull

5. Immediate Surgical Evacuation is the treatment of choice

7. Assess Pupil
If one pupil is dilated If both pupil is dilated
Put a temporal
burr hole in
ipsilateral site of
pupillary dilatation
Assess which side of pupil was dilated first
Known Not Known
Look for site of trauma
If site of
injury visible
If site of injury
not visible
Put on left side
to relieve dominant
hemisphere first
Put a temporal
burr hole in
ipsilateral site of
Pupil which was
dilated first
Put a temporal
burr hole in
ipsilateral site of
injury

8. Site = Between dura and arachnoid

9. 1) Source of bleed = Bridging plexus vein
2) Presentation: impaired consciousness at time of injury and later
may worsen due to enlargement of hematoma
3) CT : Concavo- convex hyperdense lesion
4) Treatment : Surgical evacuation
5) Mortality is much higher than EDH

10. CLASSIFICATION
Acute : SDH <3days
Sub-Acute : SDH 3-21days
Chronic : SDH>21days

11. -2-3WEEKS OLD
- any patient with head injury comes to you with symptoms 3weeks later,
always suspect CHRONIC SUB DURAL HEMORRHAGE
-Most can be treated by Burr hole evacuation
- For Non responsive cases Craniotomy should be done

12. -Indicative of Head Injury
- So in head injuries B.P will be high and which is absolutely normal and
we shouldn’t try to reduce it much unless it is peaking to very high B.P

13. -MC Cause = Trauma > Rupture of Berry Aneurysm
- Sudden transient loss of consciousness
- Severe headache mentioned as Thunderclap headache, considered worst headache
of one’s life
-Vomitings +
- No focal neurological deficits
- HESS & HUNT scale is used for it.
(need not remember grading)

14. Diagnosis
1) Investigation of choice = Non Contrast CT Scan ( IOC for all head Injuries)
2) CSF = Shows blood in CSF (Xanthochromic spinal fluid )
Note : Lumbar puncture shouldn’t be done before imaging or before excluding
hydrocephalus

16. "Triple-H" therapy is given to prevent cerebral vasospasm following
subarachnoid hemorrhage.
- Maintain hypertension, hypervolemia and hemodilution.

17. Anterior cranial fossa # Middle cranial fossa #
Sub conjunctival hemorrhage CSF Rhinorrhoea/otorrhea
Raccoon Eyes(peri-orbital
ecchymosis)
Hemotympanum
CSF rhinorrhoea Battle sign: Bruising behind ear
Carotico-cavernous fistula 7th and 8th nerve palsy
In anterior cranial fossa #, all features are present at anterior part of face like eyes/nose
In middle cranial fossa#, all features are in middle / posterior of face : ear/nose

18. Raccoon Eyes
Battle sign
Hemotympanum
Sub conjunctival
hemorrhage

19. Score: 6-8 = Indicates Coma
3-4 : 85% of dying
Maximum score = 15 Minimum score= 3