Concluded Case

Major Traumatic Brain Injury

38 yr ,M, Alleged RTA,two wheeler vs pickup van On on 19th. Evaluated at Govt Medical College,intubated and mechanically ventilated. Explained the poor prognosis and then transferred. Exam deeply sedated and medically paralyzed . Pupils 4mmr 2 mm left. All DTRs absent ( drug effect). Plantars '0' b/l. What abnormality in the CT scan,diagnosis and management.

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Concluded answer

Thanks to all answers CT brain: * Larger SDH along the fronto-temporo parietal convexity. * Intraparenchymal contusion in Rt frontoparietal region,rt basifrontal region and left frontoparietal parasagittal region. * Significant midline shift noted to the left with parafalcine herniation, brainstem rotation tothe left. * SAH noted along interhemispheric fissure,tentorium ,cerebellar folia,rt sylvianccustern,bilateral neural cistern,bilateral frontooarietotempiral,left occipital sulci. * Thick SAH bilateral frontal sulci. * pneumocephalus noted in the sella and parasellar regions. * Intraventricular hemorrhage in the 4th and 3rd ventricles. *Diffuse brain edema rt side. **Patient had undergone Rt frontotemporoparietal craniectomy with evacuation of hematoma. Still sick ,tracheostomy done,under neurosurgical ICU.

All Answers

Thanks to all answers CT brain: * Larger SDH along the fronto-temporo parietal convexity. * Intraparenchymal contusion in Rt frontoparietal region,rt basifrontal region and left frontoparietal parasagittal region. * Significant midline shift noted to the left with parafalcine herniation, brainstem rotation tothe left. * SAH noted along interhemispheric fissure,tentorium ,cerebellar folia,rt sylvianccustern,bilateral neural cistern,bilateral frontooarietotempiral,left occipital sulci. * Thick SAH bilateral frontal sulci. * pneumocephalus noted in the sella and parasellar regions. * Intraventricular hemorrhage in the 4th and 3rd ventricles. *Diffuse brain edema rt side. **Patient had undergone Rt frontotemporoparietal craniectomy with evacuation of hematoma. Still sick ,tracheostomy done,under neurosurgical ICU.

1.large subacute subdural haematoma with presence of active bleed in rt fronto _temporo_parietal convexities with significant mass effect 2. Haemorrhagic cortical contusion in rt frontal and temporal lobes3. Traces of subarachnoid and intraventricular haemorrhage. 4.sphenoid haemosinus 5.haemorrhagic scalp contusion in occipital region. Urgent neurosurgical intervention for evacuation of sdh

Very valuable suggestion.Thanks DrSasmal
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Madam gcs not mentioned.. Large sdh with haemorhagic contusion woith midline shift. Explain the bad prognosis to attenders. Ventiate the patient immediately.. Decompressive craniectomy to be done. Duroplasty &keep the reoved bone flap in the abdomen. If the pt survives cranioplasty at s later date.. Some survive too

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Hemorrhagic contusion along with large SDH on left side with significant midline shift There is blood in rt frontal and falx region also Need urgent neurosurgerical intervention

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Midline shift to left Hydrocephalus Subarchnoid haematoma rt Frontoparietal Mri c spine intubated Slow ns Opinion of neurosurgeon

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RTA with Head injury RT fronto temporal contusion with Haemorrhagic contusion With large sdh With midline shift May need decompressive craniotomy With clear prognosis explaining patient attenders Need observation

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Abnormalities increase of cerebrospinal fluid in the ventricles of the brain Hydrocephalus and retinascopy gives the eyes number firstly and treatment by neurologist

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Mid line shift with large haemorrhage

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SDH

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