英文病例一份Brain trauma :epidural hematoma
A 65-year-old right-handed man was transferred to the hospital approximately 16 hours after suffering head trauma with loss of conciousness in a motor-vehicle accident.Examination .General examination was remarkable for a left parietal scalp laceration ,left hemotympanum,and right periorbital hematoma.Funduscopic examination was within mormal limits .Neurological examination revealed an alert patient oriented to time and person but not to place.A mixecd aphasia was present with expressive and conductive elements.Sensory examination was normal.There was left-sided weakness;however,the patient did have a positiv Babinski sign on the left .The remainder of the neurological examination was normal .Skull films revealed a left parietal linear skull fracture.
.Course .The patient was admitted to the hospital for observation,and over the next 24 hours had modest but definite improvement in his aphasia.A CT scan was obtained approximately 24 hours after injury ,and this reveals a left epidural hematoma with a 3-mm shift of midline structures from left to right ,and effacement of the left lateral ventricle ,Because the patient had been improving neurological deterioration .By the 2nd day,the patient had complete resolution of his aphasia except for a very mild dysnomic component ,Follow-up CT scan on the 4th hospital day demonstratec no significant change from the performed 24 hours after admission .The patient continued to improve and was discharged asymptomatic following complete resolution of his neurological deficits and headaches on the 6th hospital day.Repeat CT scans were obtained on the 17th and 30th postinjury day .These showed guadual but complete resolution of the epidural hematoma.
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