Traumatic brain injury (intraosseous vascular access)

Case contributed by Mr Andrew Murphy


GCS 3 post assault, no IV access possible

Patient Data

Age: Unknown

Due to the patient's critical condition in conjunction with no IV access,  the decision was made to administer iodinated contrast via an intraosseous injection.


Initial imaging

Mixed hyperacute and acute bilateral subdural haematomas, with evidence of active haemorrhage on the right side. Associated mass effect with midline shift to the left of 4mm, and early bilateral downward transtentorial herniation.
Multifocal haemorrhagic cortical contusions. Small intraparenchymal basal ganglia haemorrhages reflect haemorrhagic diffuse. 
Extensive base of skull fractures
Small undisplaced fracture through the right C1 lateral mass posterolateral aspect. No other cervical spine fracture or dislocation. Degenerative spinal canal stenosis at C6/7.
No carotid or vertebral artery dissection.


Patient demonstrated no signs of improvement and was referred to nuclear medicine for a cerebral viability study.

Nuclear medicine

931 MBq Tc99m-Ceretec

Absent intracranial perfusion to the cerebral and cerebellar hemispheres. Increased tracer uptake in the extracranial structures, likely to represent shunting of blood into the external carotid arteries.

Consistent with brain death.


Case Discussion

In the context of the critically ill patient where intravenous access is not possible, iodinated contrast can be administered via an intraosseous injection. When injected intraosseously, pressure rates must be high due to the bones intramedullary pressure. 


Diagnostic report courtesy of  Dr. Gregory Lock 

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Case information

rID: 55485
Case created: 9th Sep 2017
Last edited: 10th Sep 2017
System: Trauma
Inclusion in quiz mode: Included
Institution: Princess Alexandra Hospital

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