Head CT showed traumatic subarachnoid hemorrhage in the right frontal area and basilar skull fracture of the occipital bone (Fig. After primary and secondary trauma surveys and X-rays of the chest and pelvis, whole body computed tomography (CT) was performed. A motor and sensory examination of the extremities and trunk was normal. On physical examination, there was no external wound, with only spontaneous pain and tenderness at the back of his head and neck. His medical history included paroxysmal atrial fibrillation, for which warfarin was prescribed. There was no dyspnea or right hemiplegia. He felt occipital and posterior cervical pain. On arrival, his consciousness was alert and his vital signs were stable. The physician found it difficult to diagnose and treat the patient, and he was immediately transferred to our emergency department by ambulance. However, he gradually developed dyspnea and right hemiplegia and presented to the emergency department of another hospital. He could initially walk without weakness or other symptoms. The patient was a 77-year-old man who fell from the loading platform of a truck (height 1.5 m) and landed on the back of his head. A high degree of suspicion regarding air in venous system or heart is required when patients present with such injuries. Head trauma patients with basilar skull fracture might develop vascular air embolism if physicians fail to detect air in the venous system on hospital arrival. He was discharged 34 days after admission without sequelae. He did not experience vascular air embolism after increasing of his activity level (e.g., raising his head on hospital day 3 and standing and walking alone on day 5). On hospital day 4, the air in the veins disappeared completely on CT. On hospital day 3, CT was reperformed, revealing disappearance of air in the right ventricle and decreased air in the veins of the head and neck. The patient was placed in the supine position in a state of absolute rest to prevent vascular air embolism and was treated conservatively. Whole body CT showed pneumocephalus and air in the jugular vein and right ventricle. Head CT showed traumatic subarachnoid hemorrhage in the right frontal area and basilar skull fracture of the occipital bone. His chief complaint was pain in the back of his head and neck. On hospital arrival, his consciousness was clear and his vital signs were stable. Case presentationĪ 77-year-old man fell from a truck bed and suffered head and neck trauma. The presence of air in venous system after basilar skull fracture is very rare. Air in the venous system may cause vascular air embolism, which is a potentially life-threatening event.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |