A 25-year-old male, who had hit a roadside electric pole while driving a bike under the influence of alcohol presented to emergency department in an unconscious state. He was hemodynamically stable and there was no polytrauma. He was not opening eyes to pain, not obeying but localising, making incomprehensible sounds, pupils were equal and reacting, and there were no focal deficits. There was a large left frontotemporal degloving scalp injury with elevated underlying bone fracture segment adhered to the avulsed scalp flap [Figure la]. Dural tears were seen in the exposed dura, through which cerebrospinal fluid (CSF) was leaking and pulsating brain matter could be seen. Computed tomography (CT) head [Figure Ib-d] showed a left frontotemporoorbitozygomatic elevated skull fracture (single piece) involving lateral and superior orbital roof and left frontal sinus and small contusions in the underlying brain.
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