RTA
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Mr. MHS, a 70-year-old Saudi man, was brought to the ER after a car accident. He complained of headache, neck pain, and was confused. Imaging showed old rib and clavicle fractures, as well as degenerative changes and a Grade 2 dislocation of his C5/C6 vertebrae. He was treated conservatively with a neck collar but remained unable to walk. After further review, he was admitted to the neurosurgery unit where he improved with conservative treatment and was later seen walking again, though the exact diagnosis remained unclear.
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RTA
- 2. Mr. MHS, Saudi, male, aged 70 brought in ER on 09/07/1435 with history of RTA, His car was overturned Complains of headache/pain in the neck/ no definite history of loss of consciousness/ no vomiting. P/H: No history of Hypertension/DM Had previous RTA one year back which he revealed later.
- 3. Patient was conscious but drowsy and confused, GCS 14 INJURIES: Extensive lacerated wound right parietal region of scalp and right side of the neck. Small lacerated wound right hand and right elbow. CHEST: good air entry both side, suspected fracture right clavicle no evidence of hemo/pneumothorax.
- 4. ABDOMEN: Soft and lax, no distension, no tenderness or rigidity, normal bowel sound. U/S Abdomen: NAD CNS: Conscious but drowsy and confused, GCS:14 can move all his limbs, No neurological deficit.
- 11. XRAY CHEST: shows fracture of second rib on right side, most likely old fracture. Fracture right clavicle this also may be old. No evidence of hemo/pneumothorax. XRAY PELVIS:NAD XRAY CERVICAL SPINE: Shows sub-laxation of C5/C6 vertebra, may be old also. PATIENT WAS SENT TO MOHAYEL FOR URGENT CT BRAIN AND CT CERVICAL SPINE
- 15. CT REPORT:ATROPHIC BRAIN CHANGES, CERVICAL SPINES: MARKED DEGENERATIVE SPONDYLOTIC CAHANGES/MARGINAL OSTEOPHYTIC LIPPINGS/ NARROWING OF DISC SPACE C 5/C6
- 16. Hb: 12.4 WBC:11.5 CREA: 0.8 AMYLASE:38 AST: 35 ALT: 20 ALP: 50 ALB: 3.5G RBS: 107
- 17. RTA/HEAD INJURY/GRADE 2 DISLOCATION OF C5/C6 VERTEBRA/ FRACTURE RIGHT CLAVICLE ?OLD/ FRACTURE 2nd RIB RIGHT SIDE ?OLD
- 18. Patient was admitted in ICU Treatment given: Cervical collar IV Fluids/Inj VELOSEF/Inj Paracetamol/ Inj Phenytoin FAX sent to Neurosurgeon,ACH Patient gone to ACH for Neuro- surgical evaluation on 14/07/35
- 19. NEUROSURGEON REPORT: CT Brain: NAD CT C.Spine: Degenerative changes, Cord not compensated. Advised: Conservative management Neck Collar for 6-8 weeks
- 20. Patients consciousness level improved, but he was not able to sit or stand.Can move all his limbs. Not willing to go home at all/ Even the attendents refused to take him home. REPEAT CT BRAIN AND CERVICAL SPINE WAS ADVISED
- 23. Dilated extra-axial fronto- parietal spaces ??chronic sub- dural collections ?brain atroph Grade 2 dislocation of C5/C6 Vertebra, Spondylo- degenerative changes
- 24. Another FAX was sent to Neurosurgery unit to review the case on 22/07/1435 as patient was still unable to walk. After much struggle, the patient was accepted for review and patient was sent on 30/07/1435 and he was admitted there.
- 25. After about two weeks I found my patient walking near our OPD, He was in ACH for few days and he was treated conservatively! Still the dilemma remains about exact diagnosis of the case!!!