Atypical Cerebral Concussion vs. Epidural Hematoma
Left picture: This is a possible clinical course of an atypical cerebral concussion. Right picture: These clinical courses are possible in epidural hematoma of childhood; therefore, not only the course described as classic is observed, in which there is an initial unconsciousness of short time, followed by a symptom-free interval which in turn passes over to a secondary increasing clouding of consciousness.
Left picture: In this pathology a state of clouding of consciousness is visible, changing considerably during several hours after the accident, recognizable by the difference in spontaneous eye opening and of the degree to which he relates to the environment (see the pictures from top to bottom). For instance, in the third picture from the top no reaction occurs at all in spite of strong pain stimuli. Right picture: In this clinical picture five different courses of the state of consciousness are possible, from being awake and alert to deep unconsciousness: 1. The patient is initially awake, but after that, there is more and more a clouding of consciousness. 2. Following head injury, the patient maintains a clouding of consciousness, or is unconscious. 3. The patient initially has a clouding of consciousness and wakes up after that. 4. The patient remains always awake. 5. After an initial short unconsciousness, the patient exhibits a symptom-free interval, followed by a secondary deterioration.