A Perennial Threat: A Case Series of Tree-Related Neurotrauma

Abstract

Background Despite their devastating nature, injuries due to tree-related- traumas are sparsely reported in the literature. Over the last several years, the incidence of tree-related traumatic injuries presenting to our level one trauma center, in Westchester, New York, has been concerning. The present study was undertaken to evaluate the clinical presentation, injury pattern, and outcomes of tree-related neurotrauma at our institution. In addition, we describe the injury pattern and medical management of several relevant cases of tree-related neurotrauma. Methods We conducted a retrospective analysis of tree-related neurotrauma over a five-year period from January of 2014 to March of 2019 at Westchester Medical Center (WMC) and Maria Fareri Children's Hospital, a level one trauma center. Patients presenting with neurotrauma that necessitated neurosurgical care were eligible for inclusion in this case series. Tree-related injury was defined as any trauma that was sustained as a direct result of collision with a tree. Results We identified 21 patients who sustained tree-related trauma. The cohort age ranged from 15 to 68 (mean=38 years). Injuries included seven skull fractures, four cases of subdural hematoma (SDH), six cases of intracranial hemorrhagic contusion, 14 spinal fractures, three cases of epidural hematoma (EDH), one case of spinal cord contusion, three vascular injuries, one case of dural laceration, and one case of pneumocephalus, with several patients suffering multiple injuries. Of the 21 patients, seven were female, and 12 were injured when their motor vehicle struck a tree. All but four patients were taken to the operating room for neurosurgical treatment, and nine of 21 patients were taken emergently to the operating room upon arrival. Conclusion The potential for serious head injuries with long-term neurologic sequelae exists with tree-related trauma. Clinicians should be advised of the challenging management of injuries secondary to tree-related trauma, and a greater emphasis should be placed on raising awareness of these accidental, but devastating injuries. Finally, a great majority of these injuries can be prevented or reduced in severity through helmet use and by adhering to safety guidelines.

Keywords: accidents; injury patterns; neurotrauma; outcomes; tree collisions.

Figure 1. Neuroimaging findings of Case #1

A-B: CT of the head revealing extensive comminuted bilateral frontal bone fractures that violate the anterior and posterior walls of the frontal sinuses as well as a right frontal epidural hematoma, C: MRI of the brain revealing bilateral frontal lobe T2 FLAIR hyperintensities indicative of bifrontal contusions, D-E: Postoperative CT of the head following bifrontal decompressive craniectomy, F: Postoperative CT of the head following placement of a right occipital ventriculoperitoneal shunt, G-I: Postoperative CT of the head and 3-D image reconstruction following cranioplasty

Figure 2. Neuroimaging findings of Case #2

A-B: Sagittal view computed tomography image and MRI of the cervical spine revealing a fracture-dislocation at C7-T1 with perched facets and 2-3 mm of anterolisthesis of C7 on T1, C-D: Anterior and lateral radiographs demonstrating postoperative reduction of the C7-T1 fracture and C5-T1 posterior instrumented fusion construct

Figure 3. Neuroimaging findings of Case #3

A-B: Axial and coronal views on CT of the head revealing acute comminuted depressed right temporal bone fracture, C: Right temporal lobe contusion underlying the right temporal bone fracture, D-E: Postoperative CT of the head revealing titanium mesh cranioplasty following elevation and repair of the depressed temporal bone skull fracture