Case Presentation: A 55-year-old female presented to the ED with 1 week of worsening “throbbing” headache. She reported having a continuous headache after riding a roller coaster one week ago. She denied fever, neck stiffness, weakness. She denied head trauma or recent illicit drug use Past medical history was significant fora right-sided non-traumatic subdural hematoma five years ago after cocaine use, which required evacuation. Her vital signs, complete blood count, and coagulation studies were unremarkable. Her urine drug screen was negative for cocaine. Computed tomography (CT) of the head showed a 1.2 cm thickness left-sided subacute to chronic subdural hematoma with mass effect on the cerebrum causing 9 mm rightward shift of midline. She underwent a burr hole procedure with subdural drain placement by Neurosurgery. Her hospital stay was uneventful, with the removal of the drain one day after her procedure. Repeat CT head showed significant improvement in the shift to 2-3mm. A CT angiogram of her head showed no cerebral aneurysms, AV malformations, or developmental venous anomalies. The patient was discharged home after four days.
Discussion: Though rare, roller coaster rides are associated with increased risk of SDH1,2. Our case is illustrative of this phenomenon. In North America, over 375 million people visit an amusement park every year, representing roughly an $11 billion industry3,4. One of the staples of the modern amusement park is the rollercoaster, a machine that boasts high speeds and erratic twists designed to attract thrill-seekers. While rollercoasters continue to evolve, their passengers do not. Pelletier and Gilchrist described how approximately 4 deaths occur annually that are associated with rollercoasters5. Of these, around 45% were due to medical conditions that may have been exacerbated or caused by riding a rollercoaster, and 38% were due to intracranial hemorrhages or cardiac problems. Prior SDH may have predisposed the patient to repeat SDH when exposed to the gravitational shearing forces created by rollercoasters. Bo-Abbas and Bolton described the pathophysiology as similar to shaken-baby syndrome6. The cardiovascular system must respond rapidly to G force stress to maintain adequate cerebral circulation. Alcohol, served at many amusement parks, reduces the cardiovascular system’s capacity to respond to G force stress7. Additionally, peak attendance in amusement parks occurs during the summer months, where hot weather and long lines may predispose visitors to dehydration which can also increase risk for SDH.
Conclusions: This case emphasizes the importance of considering SDH in patients presenting with headache, nausea, or vomiting following amusement park trips. Physicians should have a low threshold for ordering CT of the head for patients presenting with a similar history, even in previously healthy adult and pediatric populations.