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Introduction Traumatic brain injury is a form of acquired brain injury that results from sudden trauma to the head. Specifically, mild traumatic brain injury is a clinical diagnosis that can have significant effects on an individual's life, yet is difficult to identify through traditional imaging techniques. Case presentation This is the case of a 68-year-old previously healthy African American woman who was involved in a motor vehicle accident that resulted in significant head trauma. After the accident, she experienced symptoms indicative of mild traumatic brain injury and sought a neurological consultation when her symptoms did not subside. She was initially evaluated with a neurological examination, psychological evaluation, acute concussion evaluation and a third-party memory test using software from CNS Vital Signs for neurocognitive function. A diagnosis of post-concussion syndrome was suggested. Diffusion tensor imaging revealed decreased fractional anisotropy in the region immediately adjacent to both lateral ventricles, which was used to confirm the diagnosis. Fractional anisotropy is a scalar value between zero and one that describes the degree of anisotropy of a diffusion process. These results are indicative of post-traumatic gliosis and are undetectable by magnetic resonance imaging. Our patient was treated with cognitive therapy. Conclusion Minor traumatic brain injury is a common injury with variable clinical presentation. The system of diagnosis used in this case found a significant relationship between the clinical assessment and imaging results. This would not have been possible using traditional imaging techniques and highlights the benefits of using diffusion tensor imaging in the sub-acute assessment of minor traumatic brain injury.

Percutaneous tracheostomy techniques are gaining greater popularity in ICUs. Refinement of the percutaneous tracheostomy technique has made this a straightforward and safe procedure in appropriately selected patients. Generally, coagulopathy is a relative contraindication for surgical tracheotomy. We sought to determine its usage in high-risk patients with documented coagulopathy.

Scoring systems represent classification systems or point systems that have been designed for making quantitative statements regarding the severity of a disease, its prognosis, and its course. These systems are based on physiologic abnormalities and have been successful in measuring severity of illness among critically ill patients. Furthermore, scores may serve the purposes of assessing therapies, of quality control and of quality assurance, and of an economic evaluation of intensive care. We validated the APACHE IV benchmark for a subset of patients with severe acute pancreatitis (SAP).