by Adrien Thomas May, Karl Schaller, Marco Vincenzo Corniola. Department of Neurosurgery, Geneva.

Case description

A 24-year-old man was brought to the hospital after fainting in the street with a cranial traumatism. The patient was known for being epileptic since the end of 2016 but refused any follow up or treatment. At the Emergency Department, medical evaluation revealed a confusional state and the patient refused vigorously any medical examination. Nonetheless, no obvious neurological deficit was found, except an omnidirectional nystagmus. Furthermore, a discrete right-sided commissural asymmetry and a deviation of the tongue to the left were found.

After a couple of hours of inhospital observation, the patient neurologically deteriorated to GCS 3 with a left mydriasis; he was then intubated and sedated. The head CT scan showed a left sided acute subdural hematoma, with median line deviation to the right about 14mm.

Image 1

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* 1. What is your additional finding on the bone sequences?