Persistent retrograde amnesia following a minor trauma

Abstract Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

Download Full-text

Posterior Inferior Cerebellar Artery Aneurysm: Subarachnoid Hemorrhage after a Minor Trauma, Fusiform Dissecting Aneurysm, Treatment with a p64 Flow Diverter

The Aneurysm Casebook ◽

10.1007/978-3-319-77827-3_10 ◽

2020 ◽

pp. 1427-1432

Author(s):

Stephan Felber ◽

Ali Daoun

Keyword(s):

Subarachnoid Hemorrhage ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Flow Diverter ◽

Dissecting Aneurysm ◽

Minor Trauma ◽

Aneurysm Treatment ◽

Cerebellar Artery ◽

A Minor

Download Full-text

Rare splenic complications and specific serology: decisive diagnostic tools in two cases of visceral leishmaniasis

Italian Journal of Medicine ◽

10.4081/itjm.2011.274 ◽

2012 ◽

pp. 274-277

Author(s):

Andrea Celestini ◽

Federica Paglia ◽

Orlando Dell’ Unto ◽

Riccardo Guarisco ◽

Claudio Puoti

Keyword(s):

Bone Marrow ◽

Visceral Leishmaniasis ◽

Bone Marrow Biopsy ◽

Clinical Presentation ◽

Splenic Rupture ◽

Splenic Infarction ◽

Diagnostic Tools ◽

Minor Trauma ◽

Vector Borne ◽

A Minor

Introduction: Visceral leishmaniasis (VL) is a major endemic vector-borne disease in Southern Europe. We present two cases of VL, both characterized by splenic complications. Methods and results: Case 1: A 47-year-old female presented with effort angina, hepatosplenomegaly and pancytopenia. The clinical course was complicated by splenic infarction. Although bone marrow biopsy failed to show amastigotes, diagnosis was performed by a fast agglutinating screening test (FAST) and confirmed by a direct agglutinating test (DAT). The patient was treated successfully with AmBisome. Case 2: A 22-year-old male who had undergone a splenectomy to treat splenic rupture related to a minor trauma four months earlier presented with fever, nocturnal sweats and weight loss. The lack of pancytopenia was due to the absence of the spleen. The first biopsy did not identify parasites, but because the FAST had been positive, another bone marrow biopsy was performed, which demonstrated leishmaniasis. This patient was treated with the same schedule of AmBisome infusion. Discussion: 1) The clinical presentation of VL can be atypical, 2) splenic complications can characterize this disease, and 3) specific serology may be an important tool to reach a diagnosis.

Download Full-text

A case of cervical kyphosis after a minor trauma

ArgoSpine News & Journal ◽

10.1007/bf03040345 ◽

2008 ◽

Vol 20 (1) ◽

pp. 124-125

Author(s):

Ichiro Kikkawa ◽

Satoshi Fujita ◽

Sueo Nakama ◽

Hitoshi Okami ◽

Yuichi Hoshino

Keyword(s):

Minor Trauma ◽

Cervical Kyphosis ◽

A Minor

Download Full-text

A toddler with a persisting limp after a minor trauma

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2019-317506 ◽

2019 ◽

pp. edpract-2019-317506

Author(s):

Andrea Trombetta ◽

Ester Conversano ◽

Giorgio Cozzi ◽

Andrea Taddio ◽

Flora Maria Murru ◽

...

Keyword(s):

White Cell Count ◽

Surgical Excision ◽

List Type ◽

Minor Trauma ◽

Normal Value ◽

Reactive Protein ◽

Oral Ibuprofen ◽

History Of ◽

Wait And See ◽

A Minor

A 3-year-old toddler was admitted for a 5-day history of worsening painful limping on his left leg. History was remarkable only for a minor trauma 2 days before the onset of symptoms; the boy fell on his buttocks but was walking normally in the following days. No fever was reported. Pain was also present at night, with no response to oral ibuprofen.On physical examination, the patient refused to stand on his left leg, palpation of the left buttock evoked pain, and exorotation and abduction of the left hip were only moderately limited, without local signs of inflammation such as redness, swelling or skin warming. Blood tests showed elevated erythrocyte sedimentation rate (ESR) (98 mm/hour, normal value <20 mm/hour) with normal C reactive protein (CRP) level (0.5 mg/dL, normal value <0.5 mg/dL). His white cell count was 12 110 x 109/L, haemoglobin was 127 g/L and PLT was 430 x 109/L. Creatine kinase values were within the normal range.An X-ray of the pelvis was unremarkable. An ultrasound of the left hip showed a 2 mm articular effusion.QuestionsBased on the clinical picture and laboratory tests, what is the most likely diagnosis?Perthes disease.Pyomyositis.Septic arthritis.Bone fracture.Leukaemia.What test could confirm the diagnosis?Bone scintigraphy.CT.Bone marrow aspirate.MRI.Intra-articular puncture.What is the mainstay of management of this condition?Wait and see.Surgical excision.Antibiotic course.Antineoplastic treatment.Answers can be found on page 2.

Download Full-text

Cardiac tamponade as a late complication of a minor trauma due to syncope: A case report and literature review

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918793790 ◽

2018 ◽

Vol 27 (2) ◽

pp. 103-106 ◽

Cited By ~ 1

Author(s):

Matteo Guarino ◽

Alessandra Bologna ◽

Alfredo De Giorgi ◽

Michele D Spampinato ◽

Christian Molino ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Cardiac Tamponade ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Late Complication ◽

Minor Trauma ◽

Threatening Condition ◽

Life Threatening ◽

A Minor

Haemopericardium with cardiac tamponade following minor blunt trauma is a rare, life-threatening condition. The diagnosis of cardiac tamponade as well as therapeutic management may be delayed, since the link between trauma and illness is often overlooked. We report the case of an old woman who developed a relatively delayed cardiac tamponade due to an otherwise minor blunt chest trauma following syncope.

Download Full-text

LO027: Cervical spine injury in trauma patients 65 years and older immobilised in the prehospital setting

CJEM ◽

10.1017/cem.2016.64 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S39-S39

Author(s):

L. Lamy ◽

J. Chauny ◽

D. Ross

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Fracture Dislocation ◽

Spine Injury ◽

Trauma Patients ◽

Minor Trauma ◽

Cervical Injury ◽

Geriatric Population ◽

Spinal Immobilisation ◽

A Minor

Introduction: Following a protocol derived from the Canadian C-spine Rule (CCR), patients 65 years and older transported by ambulance after trauma require full spinal immobilisation. Immobilisation complicates the transport and the evaluation; potential side effects have been recognized. The aim of this study was to evaluate the effect of mechanism of trauma and age on the rate of cervical injury in a geriatric population. Methods: We conducted a retrospective observational study on patients 65 years and older transported by ambulance to a level-one trauma center from March 2008 to October 2013. The outcome was the rate of clinically important cervical spine injury (CICSI), defined as any fracture, dislocation or ligamentous injury needing treatment or specialised follow up. The rate was calculated in the geriatric population and in the subgroup of patients with minor trauma, defined as a fall from a standing height, a chair or a bed. We then looked at the rate of CICSI based on age to define a subgroup at lower risk of lesion. Results: We included 1221 patients with a mean age of 80 y.o. (SD = 8), 739 women (61%). CICSI was found in 53 patients (4.3%, 95% CI 3.2-5.4). This is similar to the rate found in patients 65 years and older in the NEXUS population (4.6%) and the CCR population (6.0%). The mechanism of injury was a minor trauma for 716 patients (59%). Of those, 24 patients (3.4%, 95% CI 2.1-4.7) had CICSI. The rate increased after 85 y.o in both the overall population (3.4% vs 6.4%) and the minor trauma subgroup (2.6% vs 4.4%). Conclusion: The subgroup of patients 65-84 y.o. with a minor trauma had the lower rate of cervical spine injury (2.6%). In a lot of prehospital systems, those patients are not systematically immobilised for transport. It will be interesting to review the files of all patients with CICSI to identify any possible case that would have been missed without the age criteria.

Download Full-text