A patient with a skull fracture was admitted unconscious, became conscious, and has since moved into unconsciousness again. This patient is demonstrating findings indicative of:
1. A cerebral spinal fluid leak
2. A subdural hematoma
3. An epidural hematoma
4. A subarachnoid hemorrhage
3
Rationale 1: This is not a symptom of a cerebral spinal fluid leak.
Rationale 2: Acute subdural hematomas are collections of thick, jelly-like blood that accumulate within the first 24 to 48 hours after blunt trauma. Patients usually present with a loss of consciousness and they may have focal signs such as hemiparesis or dysphagia. Subacute subdural hematomas usually develop over days to weeks following the injury. Chronic subdural hematomas are more common in older adults during the 2 to 3 weeks following the injury. Patients usually develop nonspecific symptoms such as headache, confusion, and speech deficits.
Rationale 3: Epidural hematomas usually occur in conjunction with a skull fracture and result from a laceration of the middle meningeal artery, causing bleeding between the dura mater and the skull. Approximately half of the patients who suffer this injury demonstrate the classic presentation of an initial loss of consciousness followed by a lucid interval and then a sudden reloss of consciousness with rapid deterioration in neurologic status.
Rationale 4: Subarachnoid hemorrhage, or bleeding between the arachnoid and pia matter, may result from rupture of a preexisting or a traumatic cerebral aneurysm.
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