24years old male comatose patient presented to ED after being hit in a car accident. O/e - no convulsion, there is epistaxis, no otorrhea, no rhinorrhea, pupils-B/l equally reactive,GCS - E1M4V1. What's your brain CT scan diagnosis of this case? What about management?



Ct showed bifrontal contusion,smallbleed rt hypothalamus ,blood in the ambian cistern with brain oedema .Major head injury Needs neurosurgical ICU care with active head injury protocol.Add anti epileptic med.No surgical intervention at present. REPT CT BRAIN-24 hrs or earlier if deterioration.Discussed with neurosurgeon/intensivist regarding induced hypothermia

Thank u sir

Scattered small cerebral contusions with diffuse neuronal injury and brain oedema. Contusions, in bifrontal , hypothalamus and basal cisterns Ventilatory support after intubation. Decongestive therapy with Inj mannitol infusion, Eptoin, supportive treatment.. No role of surgery . Maintain ABG,

Diffuse axonal injury Conservative line of management: ET Intubation and mechanical ventilation Prophylactic antibiotic Anticonvulsants Cerebral decongestants Analgesics Sedation Supportive management Plan for MRI brain

Thanks sir

Cortical injury, Conservative,put on E.T tube mechanical ventilation as GCS is low, anticonvulsant and mannitol or 3% NaCl, with higher I/V antibiotics sedation and . Monitor ABG/VBG, other vitals.

Thank u sir

DAI and brain stem contusions.No surgical indications.

The contusions seen are of diffuse axonal injury Anterior corpus callosal and cerebellar peduncle.....The latter making it grade IV dai

its Grade 4 Diffuse Axonal Injury brain Stem contusion with multiple small to big contusions and SAH Conservative treatment If Cerebral edema increases, mass effect go for decompression surgery start mannitol tranexa eptoin vit k restricted iv fluid according to weight

Dai grade IV Sah Tentorial sdh Conservative management only

Diffuse axonal injury

Haemorragic contusions ,diffuse axonal injury, tentorial bleed. Conservative ICU care

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