A man with parenchymal bleeding, biparietal displaced fracture and Coronal-Sagittal sutures diastases

 A 61-year-old man presented with sudden onset of excessive agitation. While walking home late in the evening, he lost his balance, fell and hit his head on the ground. He had a history of diabetes melitus, hypercholesterolemia, hypertension and coronary artery disease with a pacemaker placed a year ago. 2 years ago he had an episode of transient ischemic attack which led to a right sided hemiparesis. He was taking metformin for his diabetes melitus; metoprolol, spironolactone, ramipril for his hypertension; atorvastatin for his hypercholesterolemia; aspirin and coumadin for anticoagulation. His vitals on presentation were temperature 36,4, blood pressure 150/90, respiratory rate 18/min, pulse 78/min.CT scan on admission (see above: LEFT: brain window RIGHT: bone window) showed parenchymal bleeding, biparietal displaced fracture and Coronal-Sagittal sutures diastases.

He was considered a high-risk candidate for emergent surgery by the anesthesia team and send to the ICU for follow-up. The neurosurgery team declared the patient inoperable due to the high risk of mortality intra-operatively. He died a couple of weeks later as his health deteriorated.