CASE HISTORIES
Case 1: A 76-year-old man presented with a left-sided headache, vomiting,
and right hemiparesis. He had fallen and hit his head 3 days prior to his
hospital admission. Examination revealed lethargy and motor aphasia. CSF
was bloody. CT scan revealed a subdural hematoma. A craniotomy was performed
with evacuation of the hematoma. He was transferred to a nursing home on
dilantin and phenobarbital. A few weeks later he died suddenly. (See NPSE
102)
1. Where was the hematoma located?
2. Why was the patient given dilantin and phenobarbital?
Answers:
1. This was an acute subdural hematoma, located on the left side, compressing
the motor strip and Broca's area, as indicated by the right hemiparesis
and motor aphasia; there was also some degree of subarachnoid hemorrhage
as indicated by the bloody CSF.
2. To prevent seizures initiated by scar tissue formation
Case 2: A 34-year-old man fell from a lader and hit the back of his
head. He was rendered unconscious immediately. Within 45 minutes after arrival
at the hospital, he regained consciousness and an occipital scalp laceration
was sutured. CT scan did not indicate focal hemorrhage.
1. What type and distribution of lesions would you expect?
2. What type of neurological sequelae would you expect?
Answers:
1. contusions, especially on temporal lobe tips and the ventral surfaces
of frontal lobes (these are common locations for contusions, and contre
coup lesions are likely in this type of injury).
2. anosmia (from involvement of olfactory lobes on the ventral surface of
the frontal lobes); personality & behavioral abnormalities (from contusions
in frontal lobes and/or post-concussion syndrome)