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be particularly important in elderly patients with minor head trauma, in whom the presence of an intracranial lesion (mainly subdural hematoma) may not be predicted by clinical signs However, in children, it may be advisable to perform the scans more liberally This is underscored by the results of a study of 215 children with minor head trauma conducted by Simon and colleagues; 34 children with no known loss of consciousness and a Glasgow Coma Scale score of 15 nonetheless displayed intracranial lesions, although only 3 required surgery These minor and seemingly trivial head injuries may sometimes be followed by a number of puzzling and worrisome clinical phenomena, some insigni cant, others serious and indicative of a pathologic process other than concussion The latter are described below When they occur, a neurologic or neurosurgical evaluation is indicated Delayed Fainting after Head Injury Following an accident, the injured person, after walking about and seeming to be normal, may turn pale and fall unconscious to the ground Recovery occurs within a few seconds or minutes This is a vasodepressor syncopal attack, possibly related to pain and emotional upset, and differs in no way from the fainting that follows pain and fright without injury Such syncopal attacks also occur with injuries that spare the head, but with head injury they become more dif cult to interpret Denny-Brown described a more severe type of delayed posttraumatic collapse that we have seen only rarely Again, the patient appears to be recovering from a blow to the head, which may simply have dazed him or caused a brief period of unconsciousness, when suddenly, after a period of several minutes to hours, he collapses and becomes unresponsive for a brief time The most disquieting feature of this clinical state is a marked bradycardia, which, coupled with the lucid interval, raises the specter of an evolving epidural hemorrhage (actually, bradycardia is a late and inconstant sign of epidural bleeding) However, intracranial pressure is not raised, the disorder fails to develop further, and following a brief period of restlessness, vomiting, and headache the patient recovers completely over a period of several days DennyBrown suggested that this form of delayed posttraumatic collapse was due to a contusion of the medulla, but how this explains the sequence of clinical events is not clear The authors believe it possibly to be a severe form of vasodepressor syncope but have no rm explanation A more serious form of delayed collapse after head injury is described further on, under Concussion Followed by a Lucid Interval Drowsiness, Headache, and Confusion This syndrome occurs most often in children, who, after a concussive or nonconcussive head injury, seem not to be themselves They lie down, are drowsy, complain of headache, and may vomit symptoms that suggest the presence of an epidural or subdural hemorrhage Mild focal edema near the point of impact may be seen on MRI There is usually no skull fracture but, as Nee and colleagues point out, vomiting is associated with an increase in the incidence of skull fracture The symptoms subside after a few hours, attesting to the benign nature of the condition Transient Traumatic Paraplegia, Blindness, and Migrainous Phenomena With falls or blows on top of the head, both legs may become temporarily weak and numb, with wavering bilateral Babinski signs and sometimes with sphincteric incontinence Blows to the occiput may cause temporary blindness The symptoms disappear after a few hours It seems unlikely that these transient symptoms represent a direct localized concussive effect, caused either by indentation of the skull or by impact on these parts.

Butter y spreads (Cont) reversed iron butter y, 203 204 Buy Write Index, 115 Buying options, 51 86 call options, 52 73 put options, 73 78 risk management with, 80 86 strategy for, 78 80 Buy-write strategy (see Covered calls) C Calendar ratio spreads (see Diagonal ratio spreads) Call options: analyzing volatility, 57 59 buying, 52 73 credit spreads, 162 163 de ned, 15 delta for, 30 exercising, 69 73 exercising of put options vs, 75 76 on futures, 63 66 futures volatility, 66 69 implied volatility of, 90 91 intrinsic value of, 18 19 out-of-the money calls, 59 63 pro tability of, 53 57 selling, 99 102 Call ratio spreads, 148 151 Cash settled index options, 223

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