An injured man with acute altered mental status. Issue 3 (20th February 2018)

• Record Type: Journal Article
• Authors: Chuang, Hung-Yu; Kung, Lu-Chih; Huang, Ming-Yuan
• Is Part Of: Emergency medicine journal. Volume 35:Issue 3(2018)
• Page Start: 148
• Page End: 148
• Publication Date: 2018-02-20
• Subjects: Trauma -- Neurology -- Emergency Department; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2017-206724
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Clinical introduction: A 58-year-old man sustained injuries due to accidental fall from a height of 5 m onto a solid floor while operating a crane. He was fully conscious without external evidence of head injury when presented to the ED. The patient had multiple fractures involving the fourth, fifth and seventh of the left ribs, left iliac wing and superior ramus of the pelvis, comminuted fracture of the left femur shaft, and an open fracture of the mandible. Two hours after ED presentation, the patient developed acute confusion and lethargy, which rapidly progressed to coma and respiratory distress, and was subsequently intubated with mechanical ventilation support. Emergent CT scan of the head is shown (figure 1 ). Question: What is the most likely diagnosis? A. Cerebral haemorrhage B. Brain metastasis C. Cerebral fat embolism D. Diffuse axonal injury