Rotational head trauma with callosal contusion and C6 fracture: a high-speed motorcycle accident

Abstract

Bu yazıda, yüksek hızla motosiklet sürerken dört tekerli bir araca çarpmış 34 yaşındaki bir Arnavut erkeği olgusu sunuldu. Çarpma anında havada ekseni etrafında üç kez dön-dükten sonra motosikletinden yere düşen olgu, daha sonra derin koma klinik tablosuyla yoğun bakım ünitesinde, bilincine yeniden kavuşana kadar dokuz gün tedavi edilmiş ve uzun dönemli rehabilitasyon prosedürleri uygulanmış. Manyetik rezonans ve bilgisayarlı tomografi görüntüleri rotasyonel kafa travması açısından çok aydınlatıcıydı. Gerçekten kafatası kırıkları olmaksızın birden fazla kallozal kanama odağına ilaveten C6 vertebrasında lineer kompleks kırık hattı izlenmekteydi. Bu olgu boyun omurgasını hareketsiz durumda tespit edip ortopedik tedavi uygulanmaya uygundu. Rotasyonel açısal akselerasyonun diffüz beyin ve/veya aksonal hasarına neden olan önemli bir nedensel faktör olduğu görünmektedir. Doğrudan kafatasına gelen darbenin etyolojik önemi tartışma konusuysa da asla gö-zardı edilmemelidir.Anahtar Sözcükler: Aksonal travma; beyin travması; rotasyonel açısal akselerasyon; trafik kazası.We present the case of a 34-year-old Albanian male who was riding a motorcycle when he collided at high-speed with a four-wheel vehicle. After a triple pivotal rotation in the air at the moment of impact, he fell from the motorcycle to the ground. The clinical picture thereafter was one of deep coma, treated in the intensive care unit for nine days, until he regained consciousness and long-term rehabilitation procedures were put in place. The magnetic resonance and computed tomography images were very illustrative of a rotational head trauma mechanism, since in addition to multiple callosal hemorrhages and the lack of cranial fractures, a linear complex fracture of the C6 vertebra was seen, justifying orthopedic treatment through immobilization of the cervical spine. Rotational angular acceleration seems to be an important causative factor toward provoking diffuse brain and/or axonal injury; the etiological importance on the direct skull impact is controversial, but in any case not negligible.Key Words: Axonal injury; brain trauma; rotational angular acceleration; traffic accident. CASE REPORTA 34-year-old male (height 176 cm, weight 85 kg) was riding his motorcycle on a secondary rural road in central Albania when the motorcycle collided at high speed with a four-wheel drive vehicle. According to witnesses, the injured person was wearing a helmet and was driving approximately 50 km/hr. At the site of the accident, tracks on the ground indicating a triple pivotal rotation of the motorcycle were evident. The injured lost consciousness immediately at the site of the collision; the driver of the car causing the crash and other witnesses accompanied the patient to the nearest hospital.Upon arrival, he was in a deep coma (Glasgow Coma Scale score: 5 points) with flexion provoked only by painful stimuli; an anisocoria with left but reactive mydriasis was present. The patient was otherwise stable from the hemodynamic point of view. He was admitted in the Intensive...

Pattern of lethal trauma among swimmers colliding with a personal watercraft

“…The severity of blunt trauma is generally overshadowed by the drowning due to loss of conscience in the water. In fact, we have reported cases of survival following severe cranial trauma, but not in the setting of an aquatic environment [10].…”