291.A 43-year-old mother of two watching her son play baseball has been
hit in the side of the head with a foul ball that came from another field. She
had been knocked unconscious for a few seconds and was taken to the
emergency room of a local hospital by her husband. At the emergency
room in addition to observing a growing “goose egg” over her right tempo-
ral region, examination of her fundi with an ophthalmoscope showed sub-
tle papilledema. She was immediately sent for frontal and lateral skull
films, which showed a fracture in the frontal bone near the pterion. Head
CT showed an accumulation of blood near the fracture on both sides of the
frontal bone, but anterior to the coronal suture. What is the most likely
diagnosis given to the on call neurosurgeon to bring him into the hospital
on a Saturday afternoon?
a. Extracranial hematoma
b. Extracranial and epidural hematomas
c. Extracranial and subdural hematomas
d. Subarachnoid hemorrhage
e. Extracranial hematoma and subarachnoid hemorrhage
292.One of your patients boxes semiprofessionally. One time he was
almost knocked out by a right “hook” to the head and for about a week he
had frequent headaches and a very runny nose, which finally stopped run-
ning by itself. However, he was never able to smell with his left nostril
again. What is the most likely site of injury that explains the symptoms?
a. Fracture at the cribriform plate
b. Fracture of the lacrimal bones
c. Fracture of the nasal bones
d. A Le Fort II fracture
e. A Le Fort III fracture
Head and Neck 415