Odd head injury

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Tim,

I defer to your greater experience but I thought DAI was long term badness.
How can you have DAI that reverses over several hours?

Rob Smith 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: Friday, September 01, 2006 12:59 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Odd head injury

Dean

All I could suggest is rapidly reversing DAI, which is not usually visible
on CT. Did he get a re-scan after the GCS drop or was that the first scan.
Last q - did you check for "tik" drug?

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS  instructor
and DSTC Cape Town Course Director Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU) Clinical Head (Director): Diana
Princess of Wales Trauma Unit Department of Surgery Room 4064 Tygerberg
Hospital / University of Stellenbosch PO Box 19063 Tygerberg 7505 Western
Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Dean Lutrin
Sent: Friday, September 01, 2006 1:44 AM
To: 'Trauma &amp; Critical Care mailing list'
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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