A 46-year-old Man With an Equestrian-Related Head Injury

A46-year-old recreational rider mounted his horse to test the fit of a new saddle. As he did so, weight on the stirrup caused the saddle to slip. While the man attempted to center himself over the animal, the horse began to trot and buck. The man was ejected, landing on his head and back on a gravel driveway. The rider was wearing an ASTM (American Society for Testing and Materials)/SEI (Safety Equipment Institute)–approved equestrian helmet. Bystanders witnessed the rider get up immediately, catch the horse, remove the saddle, pasture the horse, and drive away. Although aware of his surroundings at the stable, the patient could not recall driving there and had no memory of the fall. He had a slight headache but no other symptoms. He drove to a location where he knew cell phone service was available and called his wife to transport him to the hospital. On arrival at the regional trauma center, the rider was awake and alert, complaining of a headache, but was in no other distress. His vital signs were unremarkable. He was neurologically intact, with no visible trauma, yet still could not remember the injury event. A computed tomography scan of his brain was interpreted as normal. The man was discharged from the emergency department, diagnosed with concussion syndrome. Of interest in this case was the condition of the patient’s riding helmet, which was only discovered when he later returned to the stable. A crack ran completely through the helmet’s foam structure, extending from the rear rim to the ventilation slot on top. The helmet also had several 1⁄4-inch-deep dents on the back from impact with driveway gravel. This patient’s helmet use undoubtedly prevented more serious brain injury.