LAUSR

After an accident during do-it-yourself work, firefighters found a 68-year-old male lying on the ground. He had a major avulsive scalp injury (Fig. 1a) and a complete motor deficit of the right upper limb. At admission, the Glasgow score was 14 and the capillary blood glucose level 0.30 mg/ dL. The patient suffered from diabetes and was taking Glicazide. He stated that he felt shaky before the accident, and was sweating. After re-establishment of an appropriate blood sugar level, the motor deficit did not disappear. Cerebral computed tomography revealed a left-side intraparenchymal hematoma with post-traumatic arachnoid hemorrhage (Fig. 1b). He also suffered from a simple bone fracture (Fig. 1c). Diagnosis: A traumatic, avulsive scalp injury with an intraparenchymal hematoma caused by hypoglycemia. The patient described adrenergic symptoms prior to the accident and was taking sulfonylurea, a medication at risk of hypoglycemia. The patient’s hypoglycemia had been severe; he had required firefighter-administered resuscitative assistance [1]. It was imperative to adjust his treatment because severe hypoglycemia is associated with cardiovascular and allcause mortality [2]. We also performed scalp reconstruction using a free thin anterolateral thigh flap (Fig. 1d). As in our case, free tissue transfer for scalps defects is indicated for large defects. It can provide an immediate and durable reconstruction. Flaps success rates from all sources are greater than 95% [3,4]. The intracranial hematoma explained the motor deficit of the upper limb. Primary screening (in the Emergency Department) of patients with traumatic brain injuries is essential to classify patients by the risk of intracranial pathology.