Neurological Disorders Q 83

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The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action, knowing this is compatible with:

  

     A. Skull fracture

     B. Concussion

     C. Subdural hematoma

     D. Epidural hematoma

    

    

Correct Answer: D. Epidural hematoma

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The changes in neurological signs from an epidural hematoma begin with a loss of consciousness as arterial blood collects in the epidural space and exerts pressure. The client regains consciousness as the cerebral spinal fluid is reabsorbed rapidly to compensate for the rising intracranial pressure. As the compensatory mechanisms fail, even small amounts of additional blood can cause the intracranial pressure to rise rapidly, and the client’s neurological status deteriorates quickly.

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Option A: Basilar skull fractures, usually caused by substantial blunt force trauma, involve at least one of the bones that compose the base of the skull. Basilar skull fractures most commonly involve the temporal bones but may involve the occipital, sphenoid, ethmoid, and the orbital plate of the frontal bone as well. Several clinical exam findings highly predictive of basilar skull fractures include hemotympanum, cerebrospinal fluid (CSF) otorrhea or rhinorrhea, Battle sign (retroauricular or mastoid ecchymosis), and raccoon eyes (periorbital ecchymosis).

Option B: Concussions are a subset of the neurologic injuries known as traumatic brain injuries. Traumatic brain injuries have varying severity, ranging from mild, transient symptoms to extended periods of altered consciousness. Given the usually self-limited nature of symptoms associated with a concussion, the term mild traumatic brain injury (mTBI) is often used interchangeably to refer to a concussion, though concussions are technically a subset of mTBIs.

Option C: Often, the bleeding is undetected initially, discovered as a chronic subdural hematoma. When there is a sufficient accumulation of blood to occupy a large intracranial space, the brain midline shifts toward the opposite side, encroaching on the brain structures against the inner surface of the calvarium after decreasing the volume of the lateral third and fourth ventricles. As the intracranial space becomes limited, the volumetric forces push the uncal portion of the temporal lobe toward the foramen magnum causing herniation of the brain.

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