A 10-year-old female patient arrives in the emergency department after falling from a playground slide and...
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A 10-year-old female patient arrives in the emergencydepartment after falling from a playground slide and injuring herhead. She lost consciousness at the scene but is awake on arrivalto the ED. She complains of nausea and left-sided headache butresponds to verbal commands appropriately. The neurosurgeon iscalled in to examine the patient. During the examination she losesconsciousness again, becomes hypertensive and bradycardic. Her leftpupil is now fixed and dilated. The surgeon calls the OR to set upfor an emergency procedure.
1. What is the suspected diagnosis?
2. Why was an emergency procedure ordered?
3. What is the procedure that will be performed?
4. What is the long-term prognosis for the patient?
5. What is the difference between a subdural and an epiduralhematoma?
A 10-year-old female patient arrives in the emergencydepartment after falling from a playground slide and injuring herhead. She lost consciousness at the scene but is awake on arrivalto the ED. She complains of nausea and left-sided headache butresponds to verbal commands appropriately. The neurosurgeon iscalled in to examine the patient. During the examination she losesconsciousness again, becomes hypertensive and bradycardic. Her leftpupil is now fixed and dilated. The surgeon calls the OR to set upfor an emergency procedure.
1. What is the suspected diagnosis?
2. Why was an emergency procedure ordered?
3. What is the procedure that will be performed?
4. What is the long-term prognosis for the patient?
5. What is the difference between a subdural and an epiduralhematoma?
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Answer 1:
The suspected diagnosis is epidural hematoma:
The clues to the diagnosis are:
- History of head trauma
- Lucid interval - loss of consciousness followed by improvement and then later the patient lost consciousness again.
- Loss of consciousness
- Headache and nausea ( due to an increase in  intracranial pressure)
- Bradycardia and hypertension - suggestive of increase intracranial pressure. Ipsilateral dilatation of the pupil ( due to uncal herniation with compression of the oculomotor nerve)( uncus is the innermost part of the parahippocampal gyrus)
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