Odd head injury

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Thank you all for this input. Clearly there are other things to consider. I
like the notion that perhaps it wasn't the head injury that made him
comatose, although that was my assumption. I should have pushed harder to
get another CT and perhaps I should have thought more broadly other than
head injury and a few toxins. I will try get some follow up back to the
list.

Cheers

Dean

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Jago Miloguz
Sent: Sunday, September 03, 2006 1:30 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Odd head injury

you said he was drunk, maybe it was a hypoglycemia causing the comatous
state or another drug, they all don't show up on a tox-screen.. did you
checked is he a diabetic?does he have epilepsy? or another drug used, they
all don't show up on a tox-screen. and why wouldn't they allow another CT,
don't they know about period of latency in craniocerebral trauma, but if so
surprising part is that he recovered afterwards just fine as you said.
l think that you should do another CT and EEG and follow up with
neurologist.


2006/9/1, Dean Lutrin <deanlutrin at gmail.com>:
>
> 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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