Traumatic brain injury (intraosseous vascular access)

Case contributed by Andrew Murphy
Diagnosis certain


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.

Mixed hyperacute and acute bilateral subdural hematomas, with evidence of active hemorrhage on the right side. Associated mass effect with midline shift to the left of 4mm, and early bilateral downward transtentorial herniation.
Multifocal hemorrhagic cortical contusions. Small intraparenchymal basal ganglia hemorrhages reflect hemorrhagic 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.

931 MBq Tc99m-Ceretec

Nuclear medicine

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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