Interactive Transcript
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This was a nine-year-old child who was in a severe motor
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vehicle accident. If one looks at the brain windows,
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one can see that there is hemorrhage that
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is located in the posterior fossa.
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Hematomas in the posterior fossa are unique because of
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the confined space of the infratentorial compartment.
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And there the indications for surgery are different for a
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hemorrhage that occurs in the posterior fossa
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as opposed to the supratentorial space.
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In this case,
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although it seems like there's not that much hemorrhage
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associated with the injury that we will describe,
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you can see that the fourth ventricle is
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not well visualized in this individual.
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Not only that,
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but there is hemorrhage both on the right and the
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left sides of the cerebellar hemispheres.
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You also note that the patient has extensive air
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in these soft tissues of the scalp posteriorly,
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and that scalp swelling is present both
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on the right side and the left side.
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All this becomes a little bit more clear when one
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looks at the bone windows.
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In the bone windows,
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one can see that the patient has a comminuted
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fracture of the occipital bone,
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both on the right side as well as on the left side,
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in this case,
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actually crossing the mastoid air cells on the left side,
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and with extensive involvement of the temporal bone
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as well, here, affecting the middle ear cavity.
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You'll notice that there is air in these soft tissues along
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the left temporal region because of the communication with
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the aerated mastoid air cells from the temporal bone.
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In this situation, once again,
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it is a dramatic event to have a
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posterior fossa hemorrhage,
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and this patient will be serially scanned quite rapidly
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in order to determine whether or
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not the patient is herniating.
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When one has hemorrhage in the posterior fossa,
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the cerebellar tonsils may descend through the
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foramen magnum, and if they do so,
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you may have compression of the important portions
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of the brainstem, including the medulla,
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which direct respiration as well
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as cardiovascular function.
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And this is a potential source of a patient's rapid demise
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from cerebellar hematoma with tonsillar herniation.
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