An 80-year-old woman was being examined by the hospital ER physician to determine the extent of injury. Her medical records indicated no significant history of cardiovascular disease, stroke, Alzheimer disease, or cancer. She had been taken to the emergency room after being found lying in her bathtub and unresponsive. Bleeding over the occipital region of her scalp led the physician to hypothesize that she had slipped and fallen while getting into the bath and had hit the back of her head on the edge of the tub. Because the physician suspected that a traumatic brain injury, he focused most of his attention on the neurologic examination. The physician noted superficial bruising and bleeding of the scalp in the occipital region of the woman's head. He confirmed by CAT scan that there was a large subdural hematoma above the right frontal lobe of the woman's brain. In addition, he saw that the brain had begun to shift due to the extensive bleeding. He feared that the medulla oblongata could be pushed inferiorly (herniated) through the foramen magnum into the vertebral canal. The woman went to surgery where a subdural hematoma was removed and was then admitted to the neuro intensive care unit where her intracranial pressure was monitored. After an extensive hospitalization, she was discharged from the hospital to a long term care facility for rehabilitation.
Research and discuss 2 of the following:
1. The physical findings that the subdural hematoma was found in the frontal region of the brain when the blow to the head occurred over the occipital region.
2. The physiologic effects on brain function of herniation of the medulla oblongata into the vertebral canal.
3. Discuss how alterations in intracranial pressure interfere with the function of the central nervous system.
4. Discuss how mental status can be altered with brain injury and alterations in cerebral perfusion.