Neuro Case Study.docx - Patient 1 – Two individuals come to...

Patient 1 – Two individuals come to the emergency department with head injuries. One, 25 years
old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other,
65 years old, has increasing confusion after a fall that happened earlier in the week.
a. Differentiate the pathophysiology of extradural hematoma and subdural hematoma.
Extradural Hematoma:
This issue is caused by an accumulation of blood between the dura mater and the skull. Venus
bleeds account for about 15%, and arterial bleeds are the source of about 85% of cases
(McCance & Huether, 2019). Extradural hematomas are commonly caused by car accidents,
which injure the temporal fossa. The temporal fossa is the area of the head where the temporal
artery is and gives blood supply to the temporal artery. Profuse bleeding can occur from an injury
such as a car crash involving trauma to the head, causing a meningeal vein or artery to shift in
the temporal lobe and increase ICP. Symptoms can include confusion, seizures,
fatigue/drowsiness, severe headaches, and hemiparesis (McCance & Huether, 2019). The s/s
could show up within a short or long duration of time, patient and injury depending. If there are
s/s of increased ICP the pt. will require emergency care of the hematoma to prevent further
damage.
Subdural Hematoma:
In a subdural hematoma, there is blood between the dura mater and the brain, this can be acute,
subacute, or chronic depending on the severity of the injury. ICP will increase as the hematoma
grows, this will compress bleeding veins, and can cause displacement of brain tissue (McCance
& Huether, 2019). Acute subdural injuries are commonly located on the top of the skull and can
develop rapidly, typically within hours of injury. However, a subacute hematoma can have a
growth rate that is slower and can be over 48 hours to two weeks. This type of injury is more
common in older individuals following a fall. It can take weeks or months for a chronic
hematoma to develop, during this time the clot will become enclosed in the membrane. Signs and
symptoms that a patient may experience include memory loss, aphasia, weakness, coma, and
confusion. Typically, this type of injury will also result in surgical intervention.
b. Identify the patient in the above scenario requiring immediate emergency surgical
intervention and provide a rationale for your choice.