PMC8479872_01
Timeline of presentation and outcome in this case.
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F1
Neurological examination revealed a fixed and dilated pupil on the left side with GCS of 6T after a brief sedation interruption (Figure 1).
Computed tomography head showed an acute left subdural hemorrhage with significant left-to-right midline shift.
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F2
Computed tomography (CT) scan of the head showed a 19 mm left convexity acute subdural hematoma with 14 mm of midline shift as well as uncal herniation (Figure 2).
(A) Admission electrocardiogram (ECG) showed normal QTc interval and non-specific T wave changes; (B) ECG on the post-trauma day (PTD) 3 revealed new-onset QTc prolongation and T wave inversion on the lateral leads (aVL, V5, and V6); (C) ECG on PTD 4 revealed worsening TWI on leads I, II, aVL and V2-6.
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F3
On the post-trauma day (PTD) 1, the patient had a routine admission electrocardiogram (ECG) that showed non-specific T wave changes (Figure 3A) with a normal ejection fraction (EF) on transthoracic echocardiography (TTE). That prompted a repeat ECG demonstrating a persistently prolonged QTc interval and worsening TWI on leads I, II, aVL, and V2-6. (Figure 3C) The patient continued to deny any chest discomfort or shortness of breath. Troponin I was obtained given these new ECG changes and returned mildly elevated at 0.63 ng/mL (normal range 0-0.1 ng/mL).