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Previous Volume 353:1955 November 3, 2005 Number 18 Next

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View larger version (32K): [in this window] [in a new window]   A 19-year-old man sustained a crush injury to his skull from a piece of heavy machinery. Although on initial assessment he readily followed commands, his mental status deteriorated and he required intubation for airway protection. He was rapidly transferred to our level 1 trauma center. An examination of his pupils at his arrival showed ptosis (Panel A) and anisocoria (Panel B), which aroused concern that there was uncal herniation. A high-resolution computed tomographic scan of his head did not show uncal herniation but, rather, revealed a complex fracture of the sella turcica (Panel C, arrow) and of the skull base (not shown), with impingement of the bony nerve canals and a C1 fracture. He was discharged to his home 16 days after the injury with a hard cervical collar. Subsequently, he has done well but has had occasional vertigo and tinnitus. His ocular defects have resolved.

 

Christopher Baker, M.D.
Jeremy Cannon, M.D.
Beth Israel Deaconess Medical Center
Boston, MA 02215

Related Letters:

Traumatic Cranial Nerve Palsy
Cruysberg J. R.M., Theelen T., Baker C. C., Cannon J.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:1096, Mar 9, 2006. Correspondence

This article has been cited by other articles:

• Cruysberg, J. R.M., Theelen, T., Baker, C. C., Cannon, J. (2006). Traumatic Cranial Nerve Palsy. NEJM 354: 1096-1096 [Full Text]