BETTER TO LOSE ONE MINUTE IN LIFE…THAN TO LOSE LIFE IN A MINUTE

 
A 22-year old student was struck by a rock on the left temple that flew toward him
during a violent encounter between illegal settlers and the police. He fell to the
pavement but regained consciousness in approximately 2 minutes. A laceration
approximately 3 cm superior to his left zygomatic arch was bleeding. The wound
extended from the top of his auricle almost to his eyebrow. A classmate helped him to
the sidewalk, when he said that he felt weak and unsteady. Realizing that he may have
sustained a skull fracture, his classmate drove him to the Emergency Room of a
medical center. The medical intern-on-duty during the initial examination found that the
deep tendon reflexes in his upper and lower limbs were equal. His pupils were equal in
size and constricted to light. In approximately half an hour, the patient said that he was
sleepy and wanted to lie down. His left pupil was now moderately dilated and reacted
sluggishly to light. The physician-on-duty started to perform another physical
examination, but by that time the patient was unconscious.
              The physician observed that the student’s pupil on the left was widely dilated
and did not respond to light, whereas the pupil on the right was slightly dilated but
showed a normal reaction to light.
              Several skull radiographs and a computed tomography (CT) scan of his head
were taken. As the physician was almost certain of an intracranial hemorrhage, she
called a neurosurgeon. When the specialist arrived, the radiologist reviewed the
radiographs and the CT images with him.
              Diagnosis was compressed fracture of the temporal squama, posterior to the
pterion, and an extradural hematoma.
 

1. Define the region known as the temple.

2. Delineate the cranial area known as the pterion.
3. In what part of the temporal fossa is it located?
4. Why is the pterion clinically important?
5. What artery was most likely torn?
6. What other vessel may have been torn?
7. Where would the blood collect?
8. Differentiate between an extradural and a subdural hemorrhage.
9. What effect will an extradural hematoma likely have on the brain?