The Case of the Engineer With a Critical Crushing Injury

Albert B. Lowenfels, MD


May 08, 2012

The Case

The patient was a 63-year-old man in good health who sustained a crushing injury of his right foot while selecting the foundation site for his most famous project. After examining the extensive damage to his foot, his physicians advised immediate amputation of the entire right forefoot. The patient agreed, and the operation was performed soon after the injury.

The amputation of the right forefoot was performed uneventfully, without initial complications, and the patient recovered to the extent that he could continue to review plans for the proposed structure. But about 1 week to 10 days after the operation, he became restless and developed a severe headache. He found swallowing difficult and soon developed recurrent convulsions. His face became distorted, and he became unable to speak. Nevertheless, he continued to dictate instructions to his doctors in writing, in an increasingly undecipherable script. The patient's condition deteriorated, and he died 3 weeks after the initial injury.

Medical and Family History

The patient was married and had 9 children. There were no known familial illnesses. He had lost partial function of his left hand as a result of a prior injury.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.