42yrs old male RTA patient sustained head injury,brought in ED in gasping state.The patient vomits and subsequently intubated as per ATLS guidelines.He had no history of HTN,CAD or any other vascular disease,Upon arrival findings are; O/e - CNS - Deeply unconscious pupils - B/l dilated fixed non reactive to light GCS - E1M2V1 Bp - 150/90mmhg HR - 68/mt Diagnosis and Suggest management plan and outcomes after surgery???


Left fronto temporo parietal subdural haematoma with midline shift and cerebral edema. Considering GCS 4 and bilateral dilated fixed non reactive to light, I feel all attempts at evacuation of haematoma will be futile and patient will die on operating table . Instead as already brain death is impending., better would be clearly tell the prognosis to attendants and if they wish they can take the patient home instead of wasting money on hospital expenses
SDH along left cerebral convexity with subarachnod haemorrhage with midline shift towards right side with cerebral oedema
Lt fronto temporo- parietal subdural heamorrhage, with midline shift and cerebral oedema. High risk explain and Consent. Check , secure and maintain ABCDE and Vitals. Maintain good Oxygenation, gases and Urine. Mannitol, Antiepilatic, Antiemetics, Analgesics. Urgent Neurosurgeon... Need Further evaluation and Rx....
Subdural hematoma . Midline shift. Bilateral dilated fixed pupil with falling blood pressure suggests grave prognosis . High mortality chance of about 80% .
This is a case of left Fronto tempero parietal acuteSDH with diffuse SAH. Must be evacuated as early as possible. If operated within 4 hrs after trauma then patient will improve Even if pupils are dilated and fixed. Although prognosis is not and if patient survives then he might go into vegetative stage.
Dilated fixed pupils indicates brainstem injury. Looking the present status of the patient prognosis is grave. We don't know the extent of the damaged brain which might be irreversible even though craniotomy and evacuation of blood clot should be done
Left frontotemporoparietal subdural hemorrhage with cerebral edema with midline shift. Has to be evacuated. Antiedema measures , antiepileptic drugs, mechanical ventilation maintain pco2 between 20 to 25 with head end elevation. May improve gradually.
Bp falls to 80/60mmhg on inotropes,still no reactions in pupils.Consent taken for surgery.

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Bilateral subdural haematoma with sah with mass effect. Ventilate decompressive craniotomy can be done but in view of dilated fixed non reacting pupils even surgery is not going to give results prognosis is extremely poor in this cass
emergency evacuation of subdural haematoma should be done Dilated fixed pupils is not confirmatory of brain death so give chance after explained risk
Left FTP SDH Midline shift wit cerebral odema Needs evacuation Antiepileptics Mannitol if BP maintains on inotropes Serial CT /MRI brain Echo ECG basic lab investigations
Musicogenic epilepsy induced accident?guidelines-to include E E G after music or Horn sounds to rule out M.epilepsy before issuing Licence especially Heavy Vehicle Drivers
Left subdural hemorrhage with midline shift... Immediate craniotomy with high risk or death on table consent.... Even we can try for recovery....
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