Man with lost his consciousness

Thursday, January 7, 2010
This is a non contrast CT of the Brain of 28 year old computer engineer who has been undergone RTA previous night at about 9.30 pm.At that time he was not under alcohol consumption and Soon after the attack he lost his consciousness for about 2mins and then recovered fully.
Comment on his CT-Brain???
What is Lucid Period; What is the pathophysiology behind it???


ANSWER -ACUTE LEFT SIDED FRONTO-PARIETAL EXTRADURAL HAEMATOMA OR EPIDURAL HAEMATOMA and SCALP HAEMATOMA


 
 An epidural haemorrhage results from rupture of one of the meningeal arteries that run between the dura and the skulland blood is trapped between the periostium and the meningeal layer of the dura matter.The middle meningeal artery is most commonly affected.This condition is potentially deadly because the buildup of blood may increase intra cranial pressure and compress delicate brain tissue and lead to brain stem herniation ultimately.The main cause of epidural hematoma is usually traumatic head injury.Epidural hematoma commonly results from a blow to the side of the head. The pterion region which overlies the middle meningeal artery is relatively weak and prone to injury.
Epidural bleeds from arteries can grow until they reach their peak size at 6-8 hours post injury, spilling from 25 to 75 ml of blood into the intracranial space.

CLINICAL PRESENTATION

  •     Patient is often a young adult
  •     Scalp fractures,lacerations or heamatoma
  •     Cerebrospinal fluid (CSF) otorrhea or rhinorrhea resulting from skull fracture with disruption of the dura
  •     Hemotympanum
  •     Instability of the vertebral column
  •     Lucid Interval
  •     Ipsilateral, dilated pupil on the side of the expanding lesion(3rd nerve compression)
  •     Bilateral III nerve palsy may follow as rising intracranial pressure produces tentorial herniation
  •     Signs of intracranial compression
  •     Progressive contralateral hemiplegia
  •     Tonsillar Herniation results in Cushing's reflex(Hypertension & Bradycardia)

Lucid interval
  1. lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates
  2. It occurs after the patient is knocked out by the initial concussive force of the trauma, then lapses into unconsciousness again after recovery when bleeding causes the hematoma to expand past the point at which the body can no longer compensate
  3. A lucid interval is especially indicative of an epidural hematoma.
  4. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.
  5. It can last minutes or hours

INVESTIGATIONS

  • CT scan is mandatory
  • The characteristic appearance of a CT of an extradural haemorrhage is of a biconvex, lentiform(like a lens) shaped area of increased density. Spread is limited by the adhesion of the dura to the skull. A midline shift with compression of the ipsilateral ventricle may be apparent. 
  • Skull X-ray may reveal a fracture

TREATMENT
  • The hematoma is neurosurgically evacuated through a burr hole or craniotomy
  • Stop the bleed by ligating the injured vessel branches

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15 comments

  1. Anonymous Says:
  2. subdural haematoma?

     
  3. Sonja Says:
  4. subdural haemthoma

     
  5. Anonymous Says:
  6. Epidural Hematoma

     
  7. Anonymous Says:
  8. Epidural hematoma

     
  9. Anonymous Says:
  10. epidoral ich + mid line shift + skull fx +soft tissue swelling + ..

     
  11. Anonymous Says:
  12. epidural hematoma

     
  13. Pisit Says:
  14. Comment on his CT-Brain???
    Right parieto-occipital epidural hematoma

    What is Lucid Period;What is the pathophysiology behind it???
    Lucid interval is the time that between the consciousness time after accident to the time that the patient gone to unconscious again.
    The first time of unconscious is cause by brain contusion
    and the second is the time that the brain is going to heniate.
    So Early Dx and Tx is the goal

     
  15. Anonymous Says:
  16. subdural haematoma

     
  17. Anonymous Says:
  18. comment
    its C.T. brain for subdural haematoma
    lucid interval i agree with above comments

     
  19. Anonymous Says:
  20. epidural hematoma with midline shift.need to be evacuated as soon as possible

     
  21. Anonymous Says:
  22. To everyone who thinks it's a Subdural Hematoma, Just check the name of the post...LMAO
    CTEDH---- CT of ExtraDural Hematoma..... Lols

     
  23. Anonymous Says:
  24. thank

     
  25. Anonymous Says:
  26. Right or left?

     
  27. Anonymous Says:
  28. left side of the brain..if i am not mistaken for brain imaging it is always in mirror image...

     
  29. Paul Says:
  30. The last couple of days I've been looking for info on Man with lost his consciousness and gladly I stumble into your blog, it has great info on what I'm looking and is going to be quite useful for the paper I'm working on.
    BTW is crazy how many generic viagra blogs I manage to dodge in order to get the right site and the right information.
    Thanks for the post and have a nice day

     

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