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.
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.
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
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
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
Midline shift to left Hydrocephalus Subarchnoid haematoma rt Frontoparietal Mri c spine intubated Slow ns Opinion of neurosurgeon
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
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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A 48yrs old male presented to ED having H/o sudden onset LOC and seizure with multiple episode of vomitting.K/c/o HTN not on regular treatment as advice by his family doctor.O/e CNS - conscious,alert,oriented,Right UMN facial palsy,Both pupils are normal in size.GCS-E3V4M4,Bp-170/90mmhg.Diagnosis?
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41yrs old male known hypertensive presented to emergency department today in unconscious and Decerebrate condition.Patient exhibited the symptoms of headache and vomitings since morning.Upon arrival patient GCS was 4/15,Plantar B/l Upgoing,Reflex - Exaggerated,Pupils - B/l 3mm NRTL,BP - 230/100.Neurosurgeon has seen the case and explained the poor prognosis to attendants.KINDLY GIVE YOUR OPINION ON THE CASE??
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One year old girl presented to emergency department 2 hours after fall from about 1 meter height with history of loss of consciousness , Repeated episodes of vomiting and convulsions O/e reveal GCS-E2V1M4 intubated upon arrival,Pupils -B/l Pinpoint sluggish reactive,spontaneous breathing your opinion about management??
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A 60y female come with complain of unusual talk half body pain vomiting headache slow reaction from 2days.BP 180/110.h/o old hypertension.Tab-cardace-H10 taking few days.no history of fall.what is the treatment and prognosis.
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