SummaryUnattended blunt carotid injury (BCI) has stroke high risk of stroke and screening based on injury probability is recommended. Penetrating forces are not considered high risk and concomitant BCI would go unattended. The authors report a case of a 48-year-old man who fell out of a tree on to an upright stick that penetrated his lateral neck. He presented with impalement, which was removed after surgically laying open the entire wound. The carotid sheath had been breached and the internal jugular vein was bleeding. The adjacent common carotid artery was intact and pulsating with no external evidence of injury. However, injury proximity led to vascular imaging that demonstrated intimal disruption without thrombus or stenosis. Although he remained asymptomatic on heparin, the injury progressed to cause significant lumen stenosis. Endovascular stenting re-established the vessel lumen and he remains well on aspirin 9 months later. Awareness that penetrating neck trauma may cause BCIs is important.
BACKGROUND
Postural changes in blood pressure are a commonly elicited vital sign. It is important that the measurements are reproducible in order to be clinically meaningful. This article makes recommendations about how and what to document as part of the technique of recording, on the basis of the literature.
IntroductionIn this report we discuss an unusual cause of subarachnoid haemorrhage in association with neurofibromatosis.Case presentationA previously fit 55-year-old man developed sudden onset headache with loss of consciousness. He was comatose on admission with no focal neurological signs. Numerous neurofibromas and café-au-lait patches were noted, indicating neurofibromatosis type 1 which had not been previously diagnosed. Computer Tomography brain revealed a grade IV subarachnoid haemorrhage in association with numerous vascular lesions on cerebral angiography.ConclusionA rare cause of subarachnoid haemorrhages was identified and is discussed in detail.
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