Acute subdural hematoma from a basketball

following

a

blow

*

ROBERT B. TUDOR, M.D., , Bismarck North Dakota From the Department of Pediatrics , Quain and Ramstad Clinic , Bismarck , North Dakota

Subdural

hematomas are divided into acute, subacute, and chronic types depending upon the time between injury and surgical intervention. The patient with acute subdural hematoma usually sustains a severe head injury with contusion of the cerebrum as well as bleeding into the subdural space. The symptoms of this type of hematoma occur immediately after the injury. This report describes a patient whose injury occurred from being hit by a basketball which rebounded off the metal rim. The blow resulted in acute subdural hematoma and subsequent aphasia and homonymous hemianopsia.

CASE REPORT A 17-year-old boy was playing basketball in the school gymnasium. During the game, a ball thrown by another player rebounded off the metal rim of the basket and struck our patient in the left side of the head. Within 1 hr, he developed a left-sided headache and was brought to the emergency room of the Bismarck Hospital. He was confused and vomiting. The left pupil was dilated. Neither pupil reacted to light. He had right facial weakness and right hemiparesis. Angiograms showed a large left temporal lobe mass which appeared to be an intracerebral hematoma. He was taken directly to the operating room and a left frontal-temporal craniotomy was performed. An acute subdural hematoma was found on the left side as well as a large intratemporal hematoma on the left side which extended from * Address correspondence to: Quain and Ramstad Clinic, 221 North Fifth Street, Bismarck, North Dakota 58501.

136

about 4 cm behind the temporal tip throughout the entire long axis of the left temporal lobe. The hematomas were evacuated. About 12 hr after surgery, the patient followed commands, his pupils were equal, and he moved his extremities spontaneously. Since his operation, he has been emotionally unstable and aphasic. He has a right homonymous hemianopsia secondary to the hematoma dissecting into the optic tract. He has had several injuries because of visual difficulties. He has been taking anticonvulsants.

COMMENT Doctor Erik Ritman (Head, Biodynamics Research Unit, Department of Physiology and Biophysics, Mayo Clinic, Rochester, Minnesota, personal communication, July 7, 1978) has

estimated that a basketball bouncing off the rim of a basketball net could cause the head to achieve 80 to 90 ft lb/sec momentum, i.e., approximately 6 ft/sec velocity. If the duration of the contact between the ball and the head is 0.01 sec, the head would experience 20 g acceleration. At 20 g, the transient blood pressure on the side of the head that is struck could be 350 mm Hg. This force may be enough to burst small blood vessels. The extent of our patient’s lesion illustrates how severe an injury can be when a basketball rebounds with force.

ACKNOWLEDGMENTS VanVranken, M.D., Department of Family Practice saw patient initially; and K. Mattheis, M.D., Department of Neurosurgery, Quain and Ramstad Clinic, performed the surA. E.

the

gery.

Acute subdural hematoma following a blow from a basketball.

Acute subdural hematoma from a basketball following a blow * ROBERT B. TUDOR, M.D., , Bismarck North Dakota From the Department of Pediatrics , Q...
81KB Sizes 0 Downloads 0 Views