- What is the etiology for her liver disease?
Chronic alcoholism. The alcohol leads to the accumulation of
fat in hepatocytes.
- What is the relationship of her liver disease with the trauma?
Patients with severe liver disease may have hepatic
encephalopathy which contributes to their falling and injuring themselves.
The liver disease also leads to coagulation problems, and these accentuate
the hemorrhage associated with the trauma.
- How is the CNS hemorrhage produced?
Trauma with tearing of the bridging veins below the
dura.
- How do you explain the difference in ethanol level measured on
admission and in the subdural blood clots?
The alcohol in the blood in the dural clots was not
metabolized at the same rate, having been sequestered, and represents the
level at a previous time.
- How do you explain the injury pattern that relates a posterior scalp
laceration to the orbital plate fractures?
The mechanism is a "contrecoup" injury in which the fall
backwards produced the scalp laceration, but the force was transmitted to
the opposite side of the brain to produce the orbital plate
fractures.