QuestionSBA
QuestionChoice
The middle meningeal artery is damaged in an extradural haematoma. Typically the history follows a direct blow to the side of the head resulting in a lucid interval followed by deteriorating consciousness. Furthermore, the shape of the haematoma would be biconvex rather than crescentic as described above.
10027902
b
Middle meningeal artery
QuestionChoice
This is the typical mechanism of a subarachnoid haemorrhage. It is normally described as a thunderclap headache, or a very severe sudden onset headache. On neuroimaging, the haematoma would appear almost spider-shaped (hence "arachnoid" in subarachnoid space!).
10027905
e
Ruptured berry aneurysm
QuestionChoice
The middle meningeal vein follows the same route as the middle meningeal artery so could be damaged in a direct blow to the side of the head. However, it would not cause any significant intracranial haemorrhage.
10027903
c
Middle meningeal vein
QuestionChoice
The most likely diagnosis for this patient is a chronic subdural haematoma. The history of multiple falls and the hypodensity suggests a chronic bleed. The shape of the haematoma suggests that the bridging veins have been damaged. This is more common in elderly people due to cerebral atrophy.
10027901
a
Bridging veins between cortex and venous sinus
QuestionChoice
The bridging veins are between the cortex and venous sinuses rather than the third ventricles. The sinuses drain away deoxygenated blood to the internal jugular vein whereas the ventricles are involved in maintaining and draining cerebrospinal fluid.
10027904
d
Bridging veins between cortex and third ventricle
Concept
Chapter
2693
6015
Subdural haemorrhage
Topic
191
Geriatrics
17978
A 95-year-old woman is reviewed in A+E. She is normally fit and well but has fallen a few times in the past few months. This morning she fell again and now her grandson is getting concerned. There are no obvious injuries but there are concerns she may have hit her head so a CT head is done. It shows a right-sided crescentic area of hypodensity lateral to the right parietal lobe.

What is the most likely source of bleeding?
a