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A healthy 69-year-old man was hit by a car while bicycling. On admission, he was vomiting but had a maximal Glasgow Coma Score, and no other abnormalities on neurological examination. Trauma screening suggested fractures of the left zygomatic arch, the left orbita (floor and wall), the left and right temporal bone, the right maxilla and scull base fracture. This was confirmed by a cranial CT scan of the brain ( fig 1 , top panel), that also revealed a pronounced...