Der Unfallchirurg
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After an attempted suicide with a fall from a height of 5 m, a 33 year old male suffered a subarachnoidal haemorrhage, an instable fracture of the second lumbar vertebra as well as a soft-tissue decollément in the vicinity of the right heel. Despite surgical management, the comatose patient showed slow wound-healing of the heel, making revision-surgery necessary 10 days after the first treatment. Fungi were histologically recognised, and subsequent culturing identified Scedosporium apiospermum. ⋯ CT-scans performed over the following period showed an increase in lesions in the brain suggestive for numerous abscesses. At 78 days after the initial trauma, the still comatose patient died due to a massive cerebral haemorrhage. Microbiological assessment of the soil at the site of injury revealed S. apiospermum.
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Besides evacuation of epidural or subdural hematoma, early decompressive craniectomy with duraplasty has to be performed in the neurotraumatological care of patients with moderate [Glasgow Coma Scale (GCS) score 9-12 points] or severe traumatic brain injury (TBI; GCS score