Transtentorial herniation, most severe on the right 4. Hemorrhagic infarct of right medial occipital cortex 5. Left contre-coup contusion 7. Skull fracture laceration of middle meningeal artery epidural hematoma mass effect increased intracranial pressure herniations. Herniations and increased pressure decreased cerebral perfusion ischemia, congestion and edema further increased pressure and herniation.
Contusions further contribute to edema and increased mass effect.
A 52 year old man is brought to the hospital because of sudden onset of aphasia. His wife reports that in the last few weeks he has had several episodes of difficulty speaking which lasted a few minutes, but from which he spontaneously recovered. His past medical history includes hypertension for which he takes medication, and 2 years ago he had a large myocardial infarction. At that time he spent several weeks in the cardiac care unit and has not been able to return to his job as a construction supervisor. On physical exam, he is an overweight man who appears confused and cannot express himself verbally.