Julie Schwertfeger
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Hi Margaret, I want to endorse your conclusion about your motor level on Practice Case 3. There are no key muscles there, so it is important to verify the highest level where those are intact since they are not intact through to the LE key muscle tests. In this case, we need to fight the urge to take they LE key muscle scores because of the sensory intactness above as you concluded.
Hi Alyssa,
One more insight regarding age in the practice test Q 80 is that EDH in younger age and adolescent is more of an emergency than in older people (which is where my experience if focused). The dura is not tightly adhered to the calvarium in youth and adolescence, making all of your good points Alyssa, the most emergent hematoma case of the question choices. In effect, youth TBI that causes EDH have the rapid rise in ICP as you have stated. In older aged persons, the arterial bleed is often stopped or self-limited by the tightly adhered dura and the shrunken brain diameter further lessen the emergency hierarchy level rank of this type of hematoma across the four answer choices provided. It is a nice reflection on Kleim and Jones as well – “Age Matters!”. https://medlineplus.gov/ency/article/001412.htmThank you Alyssa,
Yes, this is helpful and I appreciate you responding to my question on this. It is interesting to explore areas within my expertise and still get stumped! This is a good thing and makes this journey very worthwhile. To add to your good insights, the famous Natasha Richardson case of epidural hemorrhage is a nice review of the symptomology. Here is a link in case you do not already have this one: https://www.webmd.com/brain/news/20090319/natasha-richardson-dies-of-epidural-hematoma
Happy New Year and happy studying!
-Julie
