- Mr H A 28 Year Old Male Was Found Conscious At The Site Of A Motor Vehicle Accident Witnesses Described A Head On Col 1 (371.22 KiB) Viewed 73 times
1. Tachycardia
2. Head trauma, multiple lacerations and facial lacerations
3. Abnormal respiratory rate
4. Bruising
5. Fluctuating mental state
6. Unsteady gait
7. Increased reflexes in left arm and leg. Babinski sign
8. Edema
9. Raccoon Eyes
10. Right pupil 6mm not reactive to light
Mr H, a 28 year old male, was found conscious at the site of a motor vehicle accident. Witnesses described a head on collision of Mr H's sedan with a truck coming from the opposite direction. The sedan was badly damaged in the accident. Mr H complained of severe headache and dizziness. He had multiple lacerations in the scalp, profuse facial bleeding and a significant amount of blood in the oropharyngeal cavity. Mr H does not have any history of hypertension or diabetes. He is a non-smoker and consumes 2-3 alcoholic drinks per week. Physical examination Vital signs: Temperature 36.8 C; Pulse 140 bpm; Blood Pressure 110/70 mmHg; Respiratory rate 10 breaths/min Head: Evidence of trauma, multiple lacerations Neck: No obvious lacerations, no evidence of tracheal deviation Face: Multiple facial lacerations, oedema, racoon eyes Chest: Bruises, no deformity, no obvious lacerations Lungs: Clear Heart: Increased heart rate, no murmurs Abdomen: Soft, normal bowel sounds Extremities: A few bruises on the right arm and right leg Neurologic Exam Mental status: Fluctuating mental status, at times oriented to time and place, at other times lethargic. Could not recall what happened. Followed simple commands. Cranial Nerves: Left pupil round and reactive to light. Right pupil 6mm not reactive to light. Motor: Able to move all four extremities
Follow up Neurological examination: Motor: 4/5 strength in the left upper and lower extremity, normal strength on the right side Reflexes: Increased reflexes in the left arm and left leg. Left Babinski's sign. Gait: Unsteady Coordination: Not tested Sensory: Left arm and leg did not move in response to painful stimulation. Right arm and leg moved in response to pain.
2. On the basis of signs and symptoms identified in Question 1, where is the lesion most likely to be localised? Justify your answer on the basis of the clinical history, physical and neurological examination. (20 marks)