Key result
Conservative management avoiding antithrombotics enables successful recovery in concurrent STEMI and severe TBI.
Case Report (n=1)
No
This case highlights the clinical dilemma and multidisciplinary management of a patient presenting with simultaneous traumatic brain injury and ST-elevation myocardial infarction.
Cardiac evaluation warranted in unexplained falls with head injury; novel RCT finding extends atypical MI presentations.
A 51-year-old male patient was brought to the emergency department (ED) by paramedics after an unwitnessed fall from a height while he was working. He sustained a severe head injury with a low Glasgow Coma Scale (GCS). After securing his airway and stabilizing the patient, a CT scan of the brain was done that revealed bilateral subdural hematomas, and an electrocardiogram (EKG) revealed an ST elevation inferior wall myocardial infarction (MI), which was suggested to be the cause of his fall. With the presence of two concomitant life-threatening medical conditions, it was a predicament which of the two pathologies to target first in treatment. Ultimately, a management plan was decided following a multidisciplinary urgent meeting in the ED, which was attended by all respective teams. Initial conservative management with close neurological and cardiovascular monitoring in the intensive care unit (ICU) was deemed the safest option in this case.
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Abukalam et al. (2023) conducted a case report in Traumatic Brain Injury and Concomitant Myocardial Infarction (n=1). Conservative management (avoiding antithrombotics) and delayed decompressive craniectomy was evaluated on Clinical recovery. Conservative management of concomitant STEMI and severe traumatic brain injury, avoiding antiplatelets and anticoagulants, followed by delayed decompressive craniectomy, resulted in successful clinical recovery.
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