Neurological Disorders Q 133

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A client who had a transsphenoidal hypophysectomy should be watched carefully for hemorrhage, which may be shown by which of the following signs?

  

     A. Bloody drainage from the ears

     B. Frequent swallowing

     C. Guaiac-positive stools

     D. Hematuria

    

    

Correct Answer: B. Frequent swallowing

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Frequent swallowing after brain surgery may indicate fluid or blood leaking from the sinuses into the oropharynx. In the occurrence of a leak in the postoperative period, the patient is advised bed rest, and a lumbar drain is placed. If the leak does not improve in 24 hours, exploration and closure of the defect are to be done. Worsening of vision as a result of bleeding or manipulation and arterial hemorrhage are other immediate complications.

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Option A: Blood or fluid draining from the ear may indicate a basilar skull fracture. Basilar skull fractures most commonly involve the temporal bones but may involve the occipital, sphenoid, ethmoid, and the orbital plate of the frontal bone as well. Several clinical exam findings highly predictive of basilar skull fractures include hemotympanum, cerebrospinal fluid (CSF) otorrhea or rhinorrhea, Battle sign (retroauricular or mastoid ecchymosis), and raccoon eyes (periorbital ecchymosis).

Option C: If the patient’s fecal occult blood test does not turn blue, it is negative. If the card turns blue, this is positive and requires further gastroenterological workup. Occult fecal blood can be present secondary to several etiologies. Neoplastic causes include adenocarcinoma, gastrointestinal metastasis, lymphoma, and leiomyosarcoma. Inflammatory causes include Crohn disease, ulcerative colitis, gastritis, peptic ulcer disease, and diverticular bleeding.

Option D: Hematuria is the presence of blood in the urine. Hematuria can be gross or microscopic. Gross hematuria is visible blood in the urine. Microscopic hematuria refers to the detection of blood on urinalysis or urine microscopy. Hematuria is usually caused by a genitourinary disease although systemic diseases can also manifest with blood in the urine. Hematuria is divided into glomerular and nonglomerular hematuria to help in evaluation and management.

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