Spinal fluid in brain3/25/2023 In patients with a head injury associated with substantial energy transfer and subarachnoid hemorrhage or skull fracture, it is prudent to acquire both a CT angiogram and CT venogram to assess the integrity of arteries and dural venous sinuses. In our experience, the choice of imaging modality depends on a combination of clinical findings, mechanism of injury and site-dependent trauma protocols. Given our patient’s age and mechanism of injury, with a confirmed cervical fracture, we obtained a C-spine MRI to assess for epidural bleeding, ligamentous disruption, spinal cord edema and herniated discs. 3 Given our patient’s age, refractory headaches, persistent nausea and initial abnormal CT, with a fracture near the transverse venous sinus and torcula, we performed a CT venogram and angiogram to assess for blunt cerebrovascular injury. ![]() Repeat CT of the head and a brief period of observation has been shown to facilitate early discharge from hospital without delayed adverse outcomes. 2 However, recent evidence suggests that fewer than 10% of patients with mild traumatic brain injury and isolated traumatic subarachnoid hemorrhage have progression on repeat CT. Neurosurgical consultation is suggested for patients with decreasing GCS score, unrelenting vomiting or new focal deficits. A CT angiogram and venogram did not show any vascular injury or dural venous sinus involvement.Ĭurrent management of patients with traumatic subarachnoid hemorrhage includes admission to hospital for monitoring of neurologic status, with a repeat CT scan of the head 6–24 hours after the initial scan to evaluate for progression of any abnormalities. Computed tomography (CT) showed trace subarachnoid hemorrhage ( Figure 1), a nondisplaced occipital bone fracture ( Figure 2) and a nondisplaced right posterior C2 arch fracture ( Figure 3). ![]() We saw an 8 cm occipital scalp laceration, but no evidence of cerebrospinal fluid leak. The rest of the neurological examination was normal. Her vital signs were stable and she had a score of 13 (E3, V4, M6) on the Glasgow Coma Scale (GCS). She was amnestic to the event and had persistent headache, nausea and vomiting. 1 She was examined in the Aspen cervical collar in which she had been delivered by emergency services. In the emergency department, she underwent trauma team assessment. ![]() She hit her head on the pavement and lost consciousness for 3 minutes. ![]() Motorized vehicles that travel in physical spaces intended for pedestrians pose a threat to pedestrian safety.Ĭlinicians must have a high index of suspicion for potentially serious injuries in e-scooter collisions with pedestrians, given the substantial transfer of energy that can occur.Īlthough e-scooters have beneficial features, policies and interventions to reduce the rate and burden of injuries associated with their use are required.Ī 68-year-old woman presented to the emergency department after she was struck by an electric scooter (e-scooter) travelling at about 30 km/h while she was walking on a city sidewalk. Use of electric scooters (e-scooters) has increased dramatically around the world.
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