Been a downer week here in the ED. Seen a lot of sick people with devastating neurologic injuries, several of whom have died, and none of the survivors will have any sort of a happy outcome.
This is a gentleman who had been transferred into our county jail from a distant facility. Less than 24 hours after arrival he was found unresponsive. Again, the white stuff is blood from an intracerebral hemorrhage, likely due to elevated blood pressure (possibly cocaine-related). In this case, the blood poured into the ventricles in the central portion of the brain, which caused sudden increase in the intracranial pressure as the normal drainage of the brain was blocked. A catheter was inserted to relieve the obstruction. He too, is deeply comatose and unlikely to survive. Sadly, nobody knows whether he has any family or friends who should be notified. As of this writing he is alive in the ICU.
This is another older man who fell down several stairs, leading with his head. This is a lateral view of the upper cervical spine, and you can see that the top portion of the second vertebra -- the odontoid -- has been knocked off and pushed backwards. What you can't see is the spinal cord which is getting compressed by the fracture fragment. (The spinal cord doesn't always show up on CT scans.) He did have family at the bedside, and he too passed away shortly after arrival.