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Images in Neurology
November 2015

A Not-So-Subtle Bump on the Head

Author Affiliations
  • 1Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. 2015;72(11):1372-1373. doi:10.1001/jamaneurol.2015.2223

An unhelmeted young man fell from his longboard, hit his head, probably lost consciousness, stood up, and felt a bump. After he returned home, he acted sullen and defiant but had no recollection of the fall. Almost immediately after arrival at the emergency department, he developed head and eye turning to the right followed by forceful limb twitching. He was intubated for airway protection but was extubated successfully soon thereafter. There was marked lactic acidosis (pH, 7.23; Paco2, 38 mm Hg; Hco2, 16 mEq/L [to convert to millimoles per liter, multiply by 1]; pH base level, 11; and lactate level, 7.9 mmol/L [to convert to milligrams per deciliter, divide by 0.111]). He was given a 1000-mg intravenous loading dose of levetiracetam. Trauma evaluation also identified a scapula fracture. His neurologic examination findings were within normal limits. Computed tomographic scanning of the head showed soft-tissue swelling but no skull fracture or contusions. However, magnetic resonance imaging demonstrated cortically located hemorrhagic spots on the left side (Figure). He recovered well.

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