Latest Test Your Knowledge Question Focuses on Patient with Posttraumatic Headache

September 15, 2011

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A 30-year-old unhelmeted man was thrown from a motorcycle at approximately 40 mph. On acute admission to the hospital he was comatose with an intact brainstem examination and spontaneous respirations. He remained in this state for nearly three weeks and then awakened manifesting a nonfocal examination. However, he complained of severe headaches without any prior significant history of headache.

Brain MRI performed in the first week is shown and revealed several microhemorrhages (figures A and B), a small subarachnoid bleed (figure C) and increased T2 signal in the splenium of the corpus callosum suggestive of axonal injury. Subsequent brain imaging performed because of persistent headache was without any new findings. What is his estimated prognosis at one year, regarding the persistence of his posttraumatic headaches?

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