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To the Editor: Previous reports1 - 5 suggest that neurological injury following a roller coaster ride may occur among elderly persons, those with known malformations within the brain and spinal cord, and those receiving anticoagulant medications. We report a case of multiple cerebral contusions and subarachnoid hemorrhage occurring in a healthy person without known risk factors for these injuries following a roller coaster ride.
A healthy 47-year-old male physician experienced a transient episode of severe nausea and dysequilibrium immediately after a ride on a high-speed roller coaster, in which he had been violently swung in several directions. There was no history of head injury, either before or after this incident. Seven days later he experienced a sudden onset of diffuse headache, nausea, and vomiting. After the fourth consecutive day of these symptoms he was seen in our hospital, where he presented with meningismus, but was without focal neurological signs.
He was found to have normal clotting parameters. However, a computed tomographic scan of the brain revealed small hemorrhagic lesions in both the right frontal pole and the left temporal cortex, which were confirmed by magnetic resonance imaging (Figure 1). Cerebrospinal fluid was xanthochromic and was found to have a high bilirubin concentration, suggesting recent subarachnoid bleeding. Total cerebrospinal protein and nucleated cells were within the normal range. A digital subtraction angiogram did not reveal any aneurysms, arteriovenous malformations, or other vascular anomalies. The patient gradually recovered, and a week later, at discharge, he complained only of mild headache.
Hypointense lesion surrounded by hyperintensity (arrowhead) in the right frontal pole and hyperintense lesion in the left temporal cortex (arrow) represent areas of focal hemorrhage.
This is the first reported case, to our knowledge, of multiple cerebral contusions and subarachnoid hemorrhage occurring in a healthy person following a roller coaster ride. We are confident, on the basis of the patient's history, that he did not experience any further head trauma in the 7 days between the ride and the onset of his symptoms. This prolonged interval might be explained either by secondary subarachnoid bleeding from asymptomatic intracerebral contusions, or by delayed posttraumatic hemorrhage.
This case underlines the importance of obtaining a thorough history in the event of an otherwise unexplained intracerebral or subarachnoid hemorrhage. Although the incidence of brain injury induced by a roller coaster ride is presumably low, it might become more common with the introduction of faster and more complex rides. Riders of roller coasters should be warned about the risk of brain injuries, and improved safety features for their prevention should be considered.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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