Monday, July 20, 2009

Neurological Injuries from Car Surfin' USA

Car surfing (for those who don't know) is...
...a form of acrobatics (or an illegal stunt if performed in public traffic) in which passengers of moving vehicles perform various stunts, including hanging out of the car or 'surfing' on the hood, trunk or on the roof of the vehicle while it is in motion. Car surfing has caused several people to be killed during the course of such stunts.

The 1985 movie Teen Wolf was one movie which inspired many young people to try car surfing.[citation needed]
The Urban Dictionary has a more graphic take:
A way to commit suicide by driving a car on a very busy highway/freeway/interstate at a very high speed, setting the car into cruise control and then climbing out of the car through the window and standing on top of the car as if the driver were surfing until the car hits something.

"Some dude in Arizona went car surfing on the freeway and killed himself."
Actually, some dude [the 55 year old chief financial officer for the city of Phoenix] did die in this manner in 2004:
Keogh climbed onto the roof of his moving car after setting the cruise control around 50 miles an hour Wednesday afternoon. He then "surfed" on the top of his car on Camelback Road before falling to his death. The car eventually came to stop when it rear-ended a car waiting for a traffic light...1
A new paper in the Journal of Neurosurgery: Pediatrics (Wang et al., 2009) took the unique approach of consulting national statistics and searching the local pediatric trauma registry for cases of head injuries due to car surfing, as well as examining portrayals of this dangerous activity in the media:
A retrospective search of all major US newspaper articles was conducted using LexisNexis to help identify the factors leading to the population of car surfers. ... A search of newspaper articles reporting car-surfing accidents between June 1998 and June 2008 was conducted using the term “car surfing.” Each article was analyzed for information regarding the motivations behind the car-surfing activity and the circumstances surrounding the accident. ... This information was then correlated with the number of car-surfing fatalities identified from FARS [Fatality Analysis Reporting System, national database] between 1998 and 2006.
During the period 1995-2008, the authors identified 7 patients (11-16 yrs of age) from the local pediatric trauma records in Cleveland, OH as outlined in the table below (click to enlarge).

All 7 patients sustained their injuries between the years 2001 and 2008. In 3 of these patients, the mechanism of injury involved surfing on the back trunk of the moving vehicle; these patients accidently fell off as the vehicle braked or accelerated rapidly. Two patients fell from the hood of the vehicle, 1 patient fell from the side of the vehicle, and 1 patient jumped off after surfing on the exterior of the vehicle. All patients sustained their injuries from striking their heads on the pavement. Four patients had a loss of consciousness. ... One patient required craniotomy for emergency evacuation of an acute SDH [subdural hematoma] ... Four patients suffered long-term neurological complications, including impaired impulse control, emotional instability, chronic headaches, and memory difficulties.
Results of the Lexis-Nexis search did not surprise loyal MTV viewers and gamers:
...the television show Jackass, the video game Grand Theft Auto, and the video-sharing website YouTube depict car surfing as a popular activity. These media sources frequently portray car surfing in warm, sunny climates. To estimate whether regional differences in car-surfing fatality rates exist, we analyzed the 8 states with the highest fatality rates related to car surfing: California, Florida, New York, Texas, Michigan, New Jersey, Ohio, and Pennsylvania. ... The 3 states with the highest number of fatalities during this period of time were California (51 children), Texas (42), and Florida (40)—all states with warm, sunny climates.
In other words, Car Surfin' USA.

A sizeable literature on car surfing injuries already exists [OK, 7 articles in Pubmed]. My favorite is this one by a pair of Belgian forensic experts (Hooft & van de Voorde, 1994):
Reckless behaviour related to the use of MDMA (ecstasy): apropos of a fatal accident during car-surfing.

A 26-year-old man died from severe brain contusion after falling from a moving car during an attempt at car-surfing. Toxicological urine screening was positive for amphetamines, the blood analysis revealed a MDMA level of 0.63 mg/l and a blood alcohol concentration of 1.23 g/l. The case is another example of the bizarre and reckless behaviour which may result from the euphorogenic activity of ecstasy and the circumstances in which it is commonly used.
In conclusion, Wang et al. (2009) suggest that appropriate educational materials from health care providers and community leaders should warn of the dangers of car surfing. Media depictions of such stunts should include disclaimers, perhaps like this one:


1 The news article continues:
Phoenix officials said Keogh was suffering from a tropical parasitical disease he picked up while vacationing in Mexico a few years ago. The disease, unnamed by city officials, recently flared up.
In a neurological digression, I was curious the tropical brain parasite... could it have been neurocysticercosis? Cerebral schistosomiasis mansoni? A subsequent autopsy, however, ruled out a parasitic infection. Apparently, Keogh was under tremendous pressure at work. He may have been depressed and he may have committed suicide. But the case was declared a medical mystery when evidence of brain damage was discovered, "consistent with his symptoms being due to an underlying disease process."


Hooft PJ, van de Voorde HP. (1994). Reckless behaviour related to the use of 3,4-methylenedioxymethamphetamine (ecstasy): apropos of a fatal accident during car-surfing. Int J Legal Med. 106:328-9.

Wang A, Cohen AR, Robinson S. (2009). Neurological injuries from car surfing. Journal of Neurosurgery: Pediatrics. Published online July 17, 2009. DOI: 10.3171/2009.4.PEDS08474.

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At July 20, 2009 6:28 AM, Anonymous Geoff Aguirre said...

Although the newspaper account of Keogh's autopsy is rather vague, one brain abnormality that could have been identified in this 55 year-old with a change in personality and behavior is fronto-temporal degeneration.

At July 20, 2009 10:14 AM, Blogger The Neurocritic said...

Thanks for your expert opinion. I did consider that possibility -- he was about the right age given the earlier onset of FTD relative to AD, along with the notable behavioral changes.

I scrolled through the final (very long) newspaper article, and it seems cysticercosis was not ruled out completely by some. He had occasional seizures too.

At July 20, 2009 10:23 AM, Blogger Neuroskeptic said...

On a related brain-parasite-jackass-behaviour note, it's long been claimed that Toxoplasma gondii infection makes people more impulsive and it's been linked to car accidents.

Maybe it's also linked to car surfing.

I think this calls for a study. I'll get writing a grant application...:P

At July 20, 2009 4:53 PM, Blogger The Neurocritic said...

Neuroskeptic - Here's a good start for your grant application:

Flegr J, Klose J, Novotná M, Berenreitterová M, Havlícek J. Increased incidence of traffic accidents in Toxoplasma-infected military drivers and protective effect RhD molecule revealed by a large-scale prospective cohort study. BMC Infect Dis. 2009 May 26;9:72.

I don't know if any of the accidents were due to car surfing, however.

At July 20, 2009 4:56 PM, Blogger The Neurocritic said...

Oh, and this hyperbolic headline from ABC News might be useful too:

Cat Parasite Affects Everything We Feel and Do

With an opening like that, who wouldn't fund your grant?


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