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* NBME neuro 1
 #846055  
  kennychan - 12/04/17 16:40
 
  An 11 year-old boy with hemophilia A is brought to the physician because of headaches and decreasing school performance since failing 10 feet to the ground 2 weeks ago. He did not loss consciousness at the time and remembers striking his head. A CT scan of the head showed no abnormalities. Current examination shows bilateral papilledema and hyperreflexia on the left. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

a) Brain abscess
b) Epidural hematoma
c) Postconcussive syndrome (wrong)
d) Subarachnoid hemorrhage
e) Subdural hemorrhage
 
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* Re:NBME neuro 1
#3354283
  tchops - 12/05/17 11:22
 
  E)  
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* Re:NBME neuro 1
#3354310
  jussoju - 12/05/17 13:32
 
  E) Concussion does not have FND or increased ICP, papilledema rules it out. Vital signs are normal so its not an abscess. Epidural has a lucid interval. Subarachnoid has thunderclap headache (at times, it can just have a minor bleed - sentinel bleed- and then worsen though. The answer is Subdural hemorrhage. Subdural bridging veins are prone to rupture in head trauma, especially in children and the elderly (but can happen in anyone). The signs and symptoms can occur after weeks to months of the inciting event.  
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