Concluded Case

HEAD INJURY DUE TO PHYSICAL ASSAULT

29 year old male was brought to the emergency with a history of physical assault over a domestic issue and loss of consciousness with vomitting,The patient had no known comorbids and was not on any medication. INTERPRET CT FINDINGS WITH TREATMENT PLAN? Chief Complaints Headache, vomitting History No relevant medical history Vitals Unremarkable Physical Examination GCS - E3V4M5,Pupils - B/l NSNR

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Concluded answer

CT findings 1.Bilateral frontal haemorrhagic contusions 2.interhemispheric haemorrhage 3.Depressed fracture left frontal bone 4.SAH involving tentoreum cerebelli Treatment- 1.Start with decongestive therapy with mannitol 2.AED's - inj Eptoin × 8 hourly as the depressed fragment of frontal bone can trigger seizures 3.IV fluids 4.Neurosurgical intervention as early as possible- with removal of depressed left frontal bone fragments

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CT findings 1.Bilateral frontal haemorrhagic contusions 2.interhemispheric haemorrhage 3.Depressed fracture left frontal bone 4.SAH involving tentoreum cerebelli Treatment- 1.Start with decongestive therapy with mannitol 2.AED's - inj Eptoin × 8 hourly as the depressed fragment of frontal bone can trigger seizures 3.IV fluids 4.Neurosurgical intervention as early as possible- with removal of depressed left frontal bone fragments

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Bifrontal hemorrhagic contusion,interhemispheric bleed,hyperdense tentorium rt more than left suggestive of tentorial SDH,# frontal bone.. Needs neurosurgery reference. Active supportive management.

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Bilateral hemorrhagic contusion with depressed fracture L frontal bone with SAH. Anti epileptic, antibiotics and antacids and early neuro surgery to remove bone parts fractured.

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Medicolegal case Hence first inform to police about detail of injury whatsoever or domestic may be it is assult pt is critical There i can see laceration on frontal skull fore head with cranium lt frontal bone Fragment is inserted in lt frontal lobe with lacerations of cerebrum in frontal lobe lt side Hematoma spilling over rt mid milinein rt frontal lobe A c/o head injury with hematoma Need urgent neurosurgeon intervention Dislodging of clots evacuation and elevation of depressed frontal cranium Inj ns Inj lasix Inj manitol Inj dexamethasone 8hrly Inj Ceftriaxozone Inj epsolin 8hrly Inj tromodol+inj stemetil Inj diclofenac

Fracture of frontal bone Hydrocephalus Acute haemorrhage in frontal region Admit under neurosurgeon

No hydrocephalus seen in CT sir
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Depressed fracture of frontal bone with hemorrhagic contusion in both frontal lobe Neurosurgical intervention required urgently

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depressed fracture frontal bone with hemorrogic contusions with minimal mid line shift conservative

Fracture frontal bone with depressed segment associated with bifrontal contusion rt > lt .Needs Surgical intervention ( early )

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depressed frontal skull fracture with contusions in the bilateral frontal lobe. anti edema measure anti epileptic antibiotics analgesics neurosurgical intervention

Surgery for depressed fracture&conservative for contusion brain

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