Question

CASE STUDY C Increased Intracranial Pressure R.T. is a 16-year-old girl who has just received her driver's license. She has taken several friends to a "bush party" at a classmate's farm where beer and liquor were available. She leaves the party at 2 am after having several drinks. Her friends tease her as she attempts to put on her seat belt, and one calls her a sissy. She begins driving home without a seat belt. Her car drifts across the median and is involved in a head-on collision. Her most serious problem appears to be severe brain injury following ejection from the car. She is transported to the area trauma center, where treatment begins immediately. 1. Examination indicates papilledema in the right eye, a subdural hematoma in the temporal region, loss of consciousness and decreased responsiveness to painful stimuli. Explain how each symptom or sign is related to increased intracranial pressure 2. Describe a subdural hematoma, its location, and how it 3. R.T. develops bilaterally dilated pupils, and a CT scan 4. Surgery is performed to reduce the pressure in her developed and caused ICP. shows ventricular shift. What are the implications of these findings? cranium, and R.T. recovers but requires rehabilitation for several deficits, including problems with hearing and memory as well as comprehension of speech. How will these deficits affect her academic work? Which regions of the cortex have been damaged? One year after the accident, R.T. returns to high school, and with the aid of a special education program for persons with head injuries, she graduates.

Answer 1

1. Increased intracranial pressure exerts its effect on the structures of brain resulting in damaging the strucutres and causing them to shift. This results in injury to the brain structures which is the reason for subdural hematoma.

Increased ICP also affects the optic nerve. It leads compression of optic nerve and optic disc swelling resulting in papilledema.

Due to increased ICP, the swelling of brain develops and brain structures responsible for consciousness are damaged resulting in loss of consciousness.

With increased ICP, loss of consciousness develops. This leads to decrease in response to painful stimuli which may be completely lost if ICP keeps on rising.

2. Subdural hematoma is the hematoma located in the inside of the dura. The bleeding is present between the dura and the arachnoid membrane of the brain.

Subdural hematoma occurs due to injury to bridging veins caused by head trauma. Subdural hematoma exhibits signs and symptoms like nausea, vomiting, headache, slurred speech, difficulty breathing, seizure, sensory and motor deficits, ataxia, hearing loss.

Subdural hematoma exerts pressure on the brain and its structures. This results in increased intracranial pressure.

3. The raised ICP results in damage to occulomotor nerve affecting the size and pupillary response. PNS fibers in the oculomotor nerve become nonfunctional causing the pupil ipsilateral to the lesion to become fixed and dilated. As the ICP rises, bilateral pupilary dilatation occurs. Ventricular shift is defined as the lateral shifting of ventricle of the brain from one side to the other. This is seen due to raised ICP.

4. Hearing is affected due to injury to somatosensory cortex in the parietal lobe.

Memory and comprehension of speech is affected due to injury to Wernicke’s area in the temporal lobe.

The impairment of hearing, memory and comprehension of speech will affect the academic performance of R.T. This will impair her learning abilities. She might need special assistance in her academic works.