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In the modern world, incidents of head injuries are a common occurrence. These injuries result from masses, trauma, and stroke among other reasons. This paper centers on the discussion of brain injuries of subdural and extradural hematomas and contusions alongside their therapeutic options. When treated appropriately, these tragic injuries may have a better prognosis.
Case Study 1
After getting head injuries that resulted from a motor vehicle accident (MVA) and a fall, two individuals are rushed to the emergency department. The 25-year-old victim of MVA has a temporal lobe injury, while the other victim, a 65-year-old, is suffering from growing confusion from the fall. The pathophysiology of extradural hematoma (EH) and subdural hematoma (SH) arises if there is bleeding between the skull and the dura mater, which constitutes to around 1-2% of traumatic brain injuries (Miki, Shigemori, Oshiro, Yasuda, & Inoue , 2016). The temporal EH embodies nearly all EH as observed with the MVA patient. The bulk of these injuries are attributed to temporal fractures. It is important to note that the majority of EH arises from arterial bleeds, which may be associated with damage to the middle meningeal artery or vein (Miki et al., 2016). When such incident occurs, the possibility of causing a medial shift in the temporal lobe, thus giving rise to herniation of hippocampal and uncal gyrus, is high. When the hematoma grows in size, it leads to severe headaches, confusion, vomiting, possible seizures, and nausea among other clinical manifestations. If not treated on time, EH can cause the victim's death resulting in herniation. However, with quick treatment, his prognosis is good.
On the other hand, the 65-year-old fall victim might require surgical intervention but it is not a case of emergency. It is possible that her bleed might be growing but she is conscious, and the bleed should have either been clotted or is in the process of clotting. Compared to the arterial bleed, her bleed is venous and hence not fast.
Case Study 2
A 38-year-old man suffered a severe head trauma after hitting his head in the car's windshield, which happened after the distraction by a deer. In the type of sustained injury, the patient is likely to suffer from a coup-contracoup resulting in a brain contusion. While the windshield stopped the victim's skull, his brain was halted by the frontal feature within his skull injuring the coup (the brain's frontal lobe), and sheared his subdural veins in the process. Additionally, the rebounding of the head in the contracoup motion was sufficient to trigger his brain to bounce off the posterior portion of the interior of his skull, and in the process he injured the posterior brain, thus resulting in a shear injury. These happenings led to the cerebral contusion, also commonly referred to as the bruising of the brain. It is imperative to note that, depending on his age, the chances of having an SH or an EN are very likely. However, the SH would be more likely in case of brain hemorrhage, especially given the possibility of the coup-contracoup injury (McKee & Daneshvar, 2015). This is in addition to the patient's contusion.
Treatment Plan
Treating a brain contusion gyrates around ICP control and symptoms management. However, in case of a brain laceration, a large contusion, or a bleed, it is important to exercise it surgically. When a patient enters the emergency room, he needs to be first stabilized physiologically. Afterwards, he would then be taken to a neurological unit for further treatment where doctors would make a decision whether to conduct surgery or undertake ICP control and monitoring. It is, however, vital to note that ICP monitoring would only take place if the patient cannot obtain neurological evaluation owing to anesthesia or pain medication or when his Glasgow Coma Scale score is less than 9 (McKee & Daneshvar, 2015). This range is considered dangerous and can lead to death.
