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Washington University Experience | TRAUMA & FORENSIC | Contusions | 14A1 Contusion, Recent (Case 14) 1
Case 14 History ---- The patient was an 86yo male who was admitted to the Neurosurgery unit on 6/16 following a history of a fall, landing on the back of his head. At the time he was seen in the ER, blood was oozing from his left ear. He was admitted to the Neurosurgery ICU for observation. Skull X-rays showed a basilar skull fracture. CT scan showed a subfrontal hematoma predominantly on the right side with possible small interaxial hematoma in the right frontal area. Following the CT scan he was begun on Decadron and improved considerably, but his mental status never returned to the level noted on admission. He remained lethargic with fluctuating levels of consciousness. Because of continuing lethargy, the patient had a repeat CT scan on 6/25 which showed an extracerebral collection on the left that appeared larger than the first scan. A cerebral arteriogram on 6/27 showed a left extracerebral collection that measured about 3 cm. producing a midline shift. Following the arteriogram, the patient underwent bilateral frontoparietal craniectomies with drainage of the subdural space. A left subdural hygroma and contused right frontoparietal region were noted. Following surgery, the patient continued to deteriorate. He remained comatose and during this period he developed left lower lobe infiltrate and a pleural effusion. He continued to do poorly and expired on 7/17, 22 days after his fall. ---- At autopsy there is a right frontal subdural hematoma measuring approximately 3 cm. in diameter. Subarachnoid hemorrhages are noted focally over the lateral convexities. Similar subarachnoid hemorrhages are seen overlying the cerebellar hemispheres. ---- 14A1 There is a large contusion involving the orbital portion of the right frontal lobe and part of the left frontal lobe, right temporal lobe, lips of the sylvian fissure, and the left cerebellum.
