Helical and nonhelical CT of the head (each 5 mm in slice thickness) were performed. He was alert and had a feeling of fullness in the right ear on arrival however, there was neither definite hearing loss nor neurologic abnormalities nor cerebrospinal fluid fistula. He was urgently transported to the hospital. CaseĪ 55-year-old man hit the back of his head when he fell and then vomited. We report a case of cerebral venous air embolism in which the skull fracture caused by head trauma was not detected on first CT scan of the head. In most cases of cerebral venous air embolism caused by head trauma, computed tomography (CT) scan showed the skull fractures and the air might enter through the fractures. IntroductionĬerebral venous air embolism occurs mostly because of air entry into the brain veins due to some mechanism, including trauma, central venous catheterization, epidural catheterization, and administration through the chest drainage tube. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. Follow-up CT revealed a fracture line in the right temporal bone. A head computed tomography (CT) scan showed the air in the superior sagittal sinus however, no skull fractures were detected. The patient was a 55-year-old man who fell and hit his head. We report a case of cerebral venous air embolism following head trauma. One of the paths of air entry is considered a skull fracture. A trained member of staff should assess all patients within 15 minutes of arrival at hospital with a head injury (NICE, 2014).Cerebral venous air embolism is sometimes caused by head trauma. This case illustrates the importance of being aware of depressed skull fractures in children. He was referred to paediatric services and six months after the injury is reported to be progressing well. He was discharged home on the third post-operative day with advice on safety issues at home and in the playground. The boy improved, his hemiparesis resolved within 24 hours of surgery and he started mobilising the next day. He was admitted to the high dependency unit in the neurosurgical ward for regular observations of vital parameters, neurological status with paediatric GCS scoring and meticulous management of fluid balance and intravenous antibiotics. The boy was reviewed by the neurosurgical team and an exploration and elevation of the depressed fragment was carried out on the same day. An urgent non-contrast computed tomography scan revealed a large depressed fracture (>5mm) involving the right fronto-parieto-occipital bone (Fig 1, attached). He was reviewed by an anaesthetist and his condition was considered to be stable. A right-sided lateral soft tissue swelling and haematoma along with a depression of the underlying bones was noted on palpation of his skull. The Glasgow Coma Scale score was 12/15, which could indicate an intracranial injury and raised intracranial pressure.Ī neurological examination revealed left-sided hemi-paresis indicative of raised intracranial pressure. He was drowsy but easily roused by his parents. On arrival, his heart rate was 146/min, respiratory rate 32/min and oxygen saturation 97% in air. It is estimated that one in five patients admitted with a head injury has features suggestive of a skull fracture or have evidence of brain damage (NICE 2014).Ī one-year-old boy was brought to the emergency unit after being hit accidentally by a brick on the right side of his head. Between 33-50% of attendances are in children aged less than 15 years (NICE, 2014). It accounts for 1.4 million attendances at accident and emergency departments in England and Wales a year, of which 200,000 people are admitted to hospital (NICE, 2014). Head injury is the most common cause of death and disability in people aged below 40 years (National Institute for Health and Care Excellence, 2014). Scroll down to read the article or download a print-friendly PDF here.Nursing Times 111: 8, 20.Īuthors: Shameem Ahmed is assistant professor in neurosurgery Rupa Thenseen Frank is sister in charge, neurosurgical operation theatre both at Gauhati Medical College, Guwahati, India Siba Prosad Paul is specialty trainee in neonates at Southmead Hospital, Bristol. Citation: Ahmed S et al (2015) Diagnosing depressed skull fracture in a young child.
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