CASE HISTORY

On the evening before admission this little boy was riding on the step of a trolley bus when he fell off striking his head on the road. He was picked up crying but apparently unhurt and walked home. He had a meal and seemed quite well when he went to bed. During the night he vomited and in the early hours of the morning became comatose. The parents called in the family doctor who immediately brought the child to hospital in his car. On admission he was comatose, and virtually moribund. The pupils were unequal but no other physical signs could be elicited. He died shortly after admission. Autopsy There was no external sign of injury but there was a little haemorrhage between the scalp and the skull. In the left temporal region there was a horizontal fracture of the inner table of the skull 1 cm long. This had a torn the middle meningeal artery and there was 250ml of blood between the skull and the dura.

PATHOLOGY

The brain was fixed in situ to preserve its shape and the left half has been mounted. There is a saucer-like depression in the position of the middle meningeal haemorrhage and two small subarachnoid haemorrhages.