Page:Henrique Dumont - how a traumatic brain injury contributed to the development of the airplane.pdf/3

 DISCUSSION

This case illustrates the transition period from olden days low-energy trauma to high-energy traumatic brain injury associated with the development of cars and airplanes. Although the time elapsed between Henrique's fall and his symptom is not clear, a diagnosis of traumatic brain injury followed by a permanent deficit in the hemibody probably indicates brain injury due to cerebral contusion. Acute subdural hematomas causing cerebral hemisphere compression are usually associated with brain swelling, coma, intracranial hypertension and death in the absence of treatment. A cranial fracture, especially in the temporal region, can damage the middle meningeal artery causing epidural hemorrhage, which is potentially fatal without surgical evacuation, but is an unlikely etiology in the case in question. The possibility of ischemic or hemorrhagic stroke followed by a fall may also be considered, which may still confuse the diagnosis nowadays. If the deficit developed late, it could be related to a chronic subdural hematoma or even traumatic arterial dissection causing secondary thrombosis or embolism. It is important to remember that there were no diagnostic imaging examinations, which began in the 20th century with x-rays, angiography, pneumoencephalography, computed tomography and magnetic resonance. Likewise, neurological surgeries were not performed at that time, and it is interesting to note that today, a patient presenting with a motor deficit due to encephalic trauma and intracranial hematoma is usually operated upon, reversing deficits in some cases of early hospital admission. However, the advent of a chronic deficit interrupted Henrique's labor activities and forced the family to sell their property. Henrique's reflective period after the accident culminated in advice on his son's future, while the early distribution of the inheritance allowed Alberto to study and finance his experiences.

Alberto's father had a fundamental role in his son's development once, having perceived Alberto's fascination for machines, he directed his studies toward mechanics, physics, chemistry and electricity, different to that of his brothers. Transposing Henrique's accident to modern days, a huge farm would probably be inspected by helicopter, whose accidents are generally fatal; thus the sudden death of the patriarch could have triggered a war for succession and inheritance, possibly disrupting the development of a promising inventor.

References 62 Arq Neuropsiquiatr 2019;77(1):60-62