Traumatic brain injury resulting in brain death

Case contributed by Andrew Murphy


Fall from a ladder, isolated head injury. GCS of 3.

Patient Data

Age: 50 years
Gender: Male

Initial imaging

Bilateral temporal bone fractures and intracranial hemorrhage mostly centered intraparenchymally within the frontal temporal lobes. There are further areas of subdural, extradural and subarachnoid hemorrhages throughout the brain. Evidence of sulcal effacement and narrowing of the basal cisterns.

The patient became increasingly bradycardic and hypertensive over the next two hours.


2 hours post

Progression of the bifrontal and bitemporal intraparenchymal hematomas to moderate volume adjacent to the anterior cranial fossa floor.  The largest left frontal hematoma measures 34 mm (AP) x 17 mm (TV) x 10 mm (CC) and the right frontal lobe measuring 21 mm x 17 mm x 32 mm.

The layering of hemorrhage on the left tentorium in keeping with subdural hemorrhage maximally measuring 3 mm. Left temporal subdural hemorrhage measures 3 mm. 

Minor progression of the bilateral  hemispheric subdural hemorrhages.  No intraventricular hemorrhage redistribution.  However hemorrhage is present within the prepontine cisterns.
Progressive effacement of the cisterns is noted with no evidence of uncal or tonsillar herniation.

The intracranial pressure became harder to deal with over the next two days 


2 days post

There is an interval increase in the size of the intraparenchymal hematomas of both of the frontal lobes. 

There is now a new small subdural hematoma over the clivus 

Still no evidence of transtentorial or cerebellar tonsillar herniation.

Nuclear medicine

Cerebral blood flow study

There is an absent intracranial perfusion and tracer uptake in keeping with brain death. Hot nose sign noted. 

Case Discussion

Ladder related trauma such as this one are increasing, there is increasing research that suggest ladder related injuries and mortalities are on the rise, believed to be a result of an aging population and a do it yourself  attitude to domestic labor. The at risk group are males over the age of 45 1,2.


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Case information

rID: 48591
Published: 16th Oct 2016
Last edited: 18th Jun 2020
Inclusion in quiz mode: Included