Posttraumatic Skull or Pandora's Box? An Interesting Case of Head Injury Featuring the Entire Spectrum of Traumatic Brain Lesions in an Elderly Patient

Abstract

Traumatic brain injury (TBI) due to road traffic accident has assumed an epidemic proportion in the developing nations such as India; where a recent rise in vehicular traffic joins hands with poor road safety measures, to hand over the country it's unenviable status as the epicenter of this catastrophe. TBI can present in various forms including diffuse axonal injury, contusion, acute subdural hematoma (ASDH), epidural hematoma (EDH), subarachnoid hemorrhage (SAH), chronic subdural hematoma (CSDH), pneumocephalus, and so on. Commonly EDH occurs as a coup injury with ASDH occurring as a contrecoup injury on the diametrically opposite side. Contusion and intracerebral hematoma (ICH) can occur in both coup and contrecoup injuries. Various types of lesions can occur simultaneously in a single case of TBI. Here, we present an interesting case of TBI featuring the entire spectrum including EDH, ASDH, CSDH, SAH, ICH, pneumocephalus, fracture of a frontal bone on the same side of the brain. This report is perhaps one of its kinds in the available present literature. The mechanism and the pathophysiology of various lesions occurring simultaneously are discussed.

Keywords

traumatic brain injury - hematoma - multiple lesions - Pandora's box

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