A Rare Combination of Moderate TBI and Occipital Condyle Fracture in a Teenager: When Radiology Overrides GCS

Abstract

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in young patients. While the Glasgow Coma Scale (GCS) is commonly used for early severity assessment, clinical scores alone may not always correspond to the extent of structural damage observed on imaging. Occipital condyle fractures (OCFs) are uncommon and may remain undetected without detailed radiological evaluation. A 15-year-old female presented three hours after a motorcycle accident with GCS 12, indicating moderate TBI. Primary survey was stable, and physical examination showed only a minor facial wound. Radiological evaluation, however, demonstrated a left frontotemporoparietal subdural hematoma with 5 mm midline shift, associated contusion, and an undisplaced impacted occipital condyle fracture. The patient underwent decompressive craniectomy with hematoma evacuation and duraplasty. Her postoperative course was uneventful, including extubation on day three, transfer from intensive care on day four, and discharge after 14 days. At three months, she achieved near-complete recovery with a Glasgow Outcome Scale–Extended (GOS-E) score of 8. Comprehensive evaluation combining neurological assessment and imaging is essential in head trauma, as it allows early recognition of injuries with different management pathways and supports favorable functional outcomes.