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An injured man with acute altered mental status
  1. Hung-Yu Chuang1,
  2. Lu-Chih Kung1,2,
  3. Ming-Yuan Huang1,2
  1. 1 Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
  2. 2 Department of Medicine, Mackay Medical College, New Taipei City, Taipei, Taiwan
  1. Correspondence to Dr. Ming-Yuan Huang, Emergency Department, Mackay Memorial Hospital, No.92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan; m.c.yuan{at}


Clinical introduction A 58-year-old man sustained injuries due to accidental fall from a height of 5 m onto a solid floor while operating a crane. He was fully conscious without external evidence of head injury when presented to the ED. The patient had multiple fractures involving the fourth, fifth and seventh of the left ribs, left iliac wing and superior ramus of the pelvis, comminuted fracture of the left femur shaft, and an open fracture of the mandible. Two hours after ED presentation, the patient developed acute confusion and lethargy, which rapidly progressed to coma and respiratory distress, and was subsequently intubated with mechanical ventilation support. Emergent CT scan of the head is shown (figure 1).

Figure 1

CT scan of the head without contrast.

Question What is the most likely diagnosis?

A. Cerebral haemorrhage

B. Brain metastasis

C. Cerebral fat embolism

D. Diffuse axonal injury

  • Trauma
  • Neurology
  • Emergency Department

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  • Contributors Conception or design of the work/drafting the article: H-YC. Critical revision of the article/final approval of the version to be published: M-YH.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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