NR 603 WEEK 1 Questions and Answers
Graded A+
A 75-year-old man is involved in a motor vehicle accident and strikes his forehead
on the windshield. He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his upper extremities.
What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct answer-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
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,hands. There is typically hyperesthesia over the shoulders and arms. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic function one to
two levels below the lesion. Complete cord transection would affect motor and
sensory function distal to the lesion. Cauda equina syndrome typically presents as
low back pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the Christmas lights
on his house. The right side of his head hit the alley cement, and he lost
consciousness for about 1 minute; he woke up with a headache, but he had no other
complaints. A few hours later, the patient is brought to the emergency room by his
neighbor because of an intense headache, confusion, and left hand hemiparesis. On
examination, the patient has a bruise located over the right temporal region,
mydriasis, and right deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without contrast reveals a
lens-shaped hyper-density under the right temporal bone with mass effect and
edema. What is the most likely diagnosis?
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,Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 - Correct answer-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle
meningeal artery. Although a lucid interval ranging from minutes to hours followed
by altered mental status and focal deficits is typical for epidural hematoma, this
clinical picture is only encountered in up to 1/3 of the patients. The collection of
blood between the skull and dura mater causes an evident mass effect with
ophthalmic nerve palsy and the contralateral hemiparesis. Surgical evacuation of
the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that
connect the cerebrum to the venous sinuses within the dura. This venous
hemorrhage will result in a gradual increase of the hematoma, with a progressive
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, clinical picture over days or weeks. The CT scan will show a concave, crescent-
shaped hyper-density compared to the convex, lens-shaped hyper-density in
epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common
is the congenital berry aneurysm. The clinical picture is of a sudden, severe
headache with meningeal irritation. A CT scan will show blood in the subarachnoid
space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension
complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are no
focal neurological signs on clinical examination, will be the diagnostic procedure.
The CT scan of the patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
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Graded A+
A 75-year-old man is involved in a motor vehicle accident and strikes his forehead
on the windshield. He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his upper extremities.
What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct answer-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,hands. There is typically hyperesthesia over the shoulders and arms. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic function one to
two levels below the lesion. Complete cord transection would affect motor and
sensory function distal to the lesion. Cauda equina syndrome typically presents as
low back pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the Christmas lights
on his house. The right side of his head hit the alley cement, and he lost
consciousness for about 1 minute; he woke up with a headache, but he had no other
complaints. A few hours later, the patient is brought to the emergency room by his
neighbor because of an intense headache, confusion, and left hand hemiparesis. On
examination, the patient has a bruise located over the right temporal region,
mydriasis, and right deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without contrast reveals a
lens-shaped hyper-density under the right temporal bone with mass effect and
edema. What is the most likely diagnosis?
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
,Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 - Correct answer-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle
meningeal artery. Although a lucid interval ranging from minutes to hours followed
by altered mental status and focal deficits is typical for epidural hematoma, this
clinical picture is only encountered in up to 1/3 of the patients. The collection of
blood between the skull and dura mater causes an evident mass effect with
ophthalmic nerve palsy and the contralateral hemiparesis. Surgical evacuation of
the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that
connect the cerebrum to the venous sinuses within the dura. This venous
hemorrhage will result in a gradual increase of the hematoma, with a progressive
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
, clinical picture over days or weeks. The CT scan will show a concave, crescent-
shaped hyper-density compared to the convex, lens-shaped hyper-density in
epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common
is the congenital berry aneurysm. The clinical picture is of a sudden, severe
headache with meningeal irritation. A CT scan will show blood in the subarachnoid
space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension
complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are no
focal neurological signs on clinical examination, will be the diagnostic procedure.
The CT scan of the patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
