Odd head injury

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Interesting problem.  Glad he got better.
Could a seizure have been missed?

Jonathan Marrow
Wirral, UK

----- Original Message ----- 
From: "Dean Lutrin" <deanlutrin at gmail.com>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Friday, September 01, 2006 12:43 AM
Subject: Odd head injury


> Dear Listmembers
>
> I would like an opinion on a recent case I saw. Young male thrown off a
> bridge - didn't get any more details. Came in slightly confused (GCS 
> 14/15)
> with a a fractured wrist and ankle. It was one of those nights in a
> Johannesburg trauma unit and I had to run off to sort out another patient
> and I left my patient with one of the interns. I wasn't too worried about
> him compared with the other patients I had to sort out. Came back to him 
> an
> hour later and he was comatose. GCS 3/15. Intubated without drugs. CT 
> brain
> normal. Nothing else on imaging aside from wrist and ankle. Ventilated
> overnight with good spontaneous respiratory effort and reactive pupils. 
> GCS
> still 2/10. Next day started waking up quite nicely. Extubated 36 hours
> after initial injury with full recollection of everything up to arrival at
> hospital. Resources didn't allow me to CT again before extubation. Full
> toxic screen negative, but patient was drunk.
>
> Questions
>
> 1. was this just a concussion?
> 2. I have never seen a patient drop to 3/15 from 14/15 with a normal CT 
> and
> then have a full recovery. Is it common?
> 3. Anything else could have caused it?
>
> Thanks
>
> Dean Lutrin
> JHB, SA
>
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