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HISTORY: The patient is a 16-year-old, right-handed male with a history of substance abuse including alcohol, cocaine, crack (cocaine), heroin, and “angel dust” and a severe learning disability for which he had been receiving special education services. He was admitted to the ER by ambulance after falling off the back of a moving pick-up truck. On examination, his pupils were fixed and dilated and he was nonresponsive. Emergency CT scan showed a depressed right temporo-parietal skull fracture and an epidural hematoma with a moderate degree of mass effect and shift from right to left. A craniotomy was performed and the hematoma was successfully evacuated. The patient, however, remained in a comatose, but medically stable state for seven weeks. An EEG obtained during that period showed moderate bi-hemispheric slowing. He was independently breathing, not requiring ventilation. Repeat CT scan showed areas of mixed attenuation within the left frontal lobe at the level of the lateral ventricles; this study was otherwise normal. On awakening from coma, the patient was placed on phenytoin sodium (Dilantin) for seizure prophylaxis and discharged to the head injury unit. Multidisciplinary evaluations were conducted during the course of his stay.

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