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    Arvin O-Café
    A 50-year-old man was found unconscious after drinking at a casino for 3 hours. He was brought to the hospital with a bruise on his head and unequal pupils. A CT scan showed an acute subdural hematoma in the right fronto-parietal region of his brain. During surgery, a large blood clot was discovered and removed from between the dura and brain surface, likely caused by tears in the bridging veins from head trauma experienced while intoxicated.

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    Surg Path Last

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    Arvin O-Café
    58 views4 pages
    A 50-year-old man was found unconscious after drinking at a casino for 3 hours. He was brought to the hospital with a bruise on his head and unequal pupils. A CT scan showed an acute subdural hematoma in the right fronto-parietal region of his brain. During surgery, a large blood clot was discovered and removed from between the dura and brain surface, likely caused by tears in the bridging veins from head trauma experienced while intoxicated.

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    A 50-year-old man was found unconscious after drinking at a casino for 3 hours. He was brought to the hospital with a bruise on his head and unequal pupils. A CT scan showed an acute subdural hematoma in the right fronto-parietal region of his brain. During surgery, a large blood clot was discovered and removed from between the dura and brain surface, likely caused by tears in the bridging veins from head trauma experienced while intoxicated.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    58 views4 pages

    Surg Path Last

    Uploaded by

    Arvin O-Café
    A 50-year-old man was found unconscious after drinking at a casino for 3 hours. He was brought to the hospital with a bruise on his head and unequal pupils. A CT scan showed an acute subdural hematoma in the right fronto-parietal region of his brain. During surgery, a large blood clot was discovered and removed from between the dura and brain surface, likely caused by tears in the bridging veins from head trauma experienced while intoxicated.

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    CASE 04:

    A 50 year old man has been drinking for 3 hours while playing at the casino. He wanders off,
    and 5 minutes later is found lying down on the floor. Paramedics arrive, and discover a bruise on
    his posterior occiput, but no other signs of trauma. He is transported to the hospital in stable
    condition, with vital signs showing temperature 36.9°C, pulse 81/minute, respirations 20/minute,
    and blood pressure 115/80 mm Hg. On arrival, his blood ethanol is 330 mg/dL. He becomes
    progressively obtunded. His right pupil is 8 mm and the left 4 mm. A Head CT Scan was
    requested with a possible surgical procedure after the scan.

    Head CT Scan:

    Intraoperative finding reveal collection of blood after the fronto-parietal region of the cerebrum
    was exposed and after the dura has been reflected back.
    Final Dx: Acute Subdural Hematoma, Right Fronto-Parietal Region
    Gross:
    Subdural Hematoma

    There is a large, firm, partially organized


    haematoma in the subdural space
    compressing the brain surface.
    (Bleeding likely from tear in bridging veins
    travelling from brain surface through
    subarachnoid and subdural spaces to empty
    into superior sagittal sinus)

    With head trauma, the dura moves with the


    skull, and the arachnoid moves with the
    cerebrum,. As a result, the bridging veins are
    sheared causing hematoma in the expansile
    subdural space.

    The dura has been reflected back (with a


    small portion visible at the lower right) to
    reveal a subdural hematoma. Such a blood
    clot is usually the result of trauma with
    tearing of the cerebral bridging veins at the
    vertex. The venous source means that the
    bleeding may be slow and blood collects
    over a variable length of time, leading to
    neurologic signs and symptoms within hours
    to days or even weeks.

    Microscopic

    Acute on chronic subdural haemorrhage. The areas of organizing haematoma are seen closer to
    the dura, while the fresh bleed is seen lower down.
    Area of fresh (acute) subdural haemorrhage, comprising mostly red blood cells and occasional
    leukocytes.

    The areas of organizing haematoma are seen closer to the dura, and are composed of
    fibroblasts, small blood vessels and scattered inflammatory cells.

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