Multifocal Subdural Hematoma in a Teenager after a Fourth-Dimension Roller Coaster Ride

Abstract

A 16 year-old previously healthy female went on a fourth dimension (4D) roller coaster ride 3 days prior to the current presentation. During the ride she had repetitive back and forth movements and her head jerked backwards and hit the seat. She gradually developed nausea and vomiting after the ride. The symptoms persisted and she visited her primary care physician two days prior to the presentation. A concussion was suspected, and no imaging was pursued at that time. Her nausea and vomiting further worsened, and she visited a local emergency department. A computed tomographic head scan showed subdural hematoma (SDH) including over the right convexity, the falx, and the tentorium. No skull fractures were identified. The patient was transferred to our hospital for further management. Repeat imaging confirmed stability of the SDH. Additional work-up studies including magnetic resonance angiography and blood count, prothrombin time, and partial thromboplastin time didn’t reveal any apparent coagulopathy. Considering the onset of symptoms and her clinical picture, and the results of the work-up studies, the 4D roller coaster ride was suspected as an etiology of her multifocal SDH. To date, there are two reported cases of SDH in children after a roller coaster. Both cases were females who developed convexity SDH after riding a traditional roller coaster. Other reports documented adult cases, and traditionally, atrophic brain in elderly individual is known to be associated with development of SDH. The current report describes a first reported case of multifocal SDH after a ride of 4D roller coaster which occurred in a previously healthy young teenager. 4D roller coaster is a type of roller coaster that includes a “free spin” feature enabling 360 degrees rotational acceleration to the seats. This type of roller coaster has been introduced relatively recently and currently no literatures are available to suggest possible injury risks after a ride. Our report highlights a rare but possible risk of developing SDH after a 4D roller coaster ride even in the pediatric population and also a possible association between the development of multifocal SDH and multi-directional forces and rotations in a 4D roller coaster ride.