Concluded Case

41/M presents with traumatic brain injury

32yrs/M presented with severe traumatic brain injury in a car vs truck accident, unresponsive and gasping,Intubated and mechanically ventilated due low GCS upon arrival.O/e - GCS -4/15,Pupils - B/l Dilated fixed non reactive to light,BP - 90/60,PR -48.poor prognosis explained to relatives by Neurosurgeon.INTERPRET CT BRAIN AND DISCUSS PROGNOSIS?

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41yrs/M H/o severe trauma to head,GCS 4/15,dilated pupils non reactive to light, Hypotension and bradycardia. CT scan head shows multiple skull fractures,internal bleeding and edema and midline shift and compressed ventricles,indicating tentorial herniation that presses midbrain and brain stem,causes haemodynamically instability.PATIENT IS IN VEGETATIVE STATE

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Multiple fractures of skull bone at right frontal , fronto- temporal and left frontal bone significantly depressed fracture. There are hemorrhagic cerebral contusions both frontal lobes . The degree of fracture- indicates the severity of brain parenchymal injury in a head on collision. There is significant cerebral iedema , anoxia and Sub- arachnoid haemorrhage . Significantly compressed and distorted ventricles. No neurosurgical intervention can help . Prognosis remains extremely poor . Rightly patient has,been intubated and on ventilatory support- the only way to reduce ICP . Supportive treatment is all that can be given like decongestive therapy with Mannitol , AED 's , maintaining hydration and vitals . Only if patient survives and show signs of some improvement- elevation of depressed fractures can be considered

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Multiple # both frontline bones ,depressed # left frontalbone. Puctate hemorrhage both frontal left more than rt. Frontal horns of both lateral ventricle are deformed.There is blood in the rt sylvian fissure,interhemispheric fissure ,suprasellar cistern, ambian cistern ,tentorium cerebelli rt ,> left. Major traumatic brain injury with multiple # . Prognosis is extremely poor. Suggest supportive management.Punctate hemorrhage is in favour of axonal injury,and no definite indication for surgery

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This pt have diffuse injury with dai, second thing continue medical treatment , however bifrontal craniotomy with decompression is require when vital parameters will become normal or within , near to normal , till then do all blood workup ,ABG CBC RBS LFT KFT ,RULE OUT ASSOCIATED INJURY, supportive treatment , cerebral decongestant poor prognosis should be explain to this pt .

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DIFFUSE AXONAL INJURY, SUPPORTIVE FOR NOW, ANTI EDEMA, LEVETERECETAM, SOME PATIENTS COME OUT. THIS TYPE OF CASES ARE UNOREDICTABLE, WHAT THEY REQUIRE GOOD NURSING CARE, SVOID SECONDARY INFECTION, DVT PROPHYLAXIS, NUTRITION, PREVENT ASPIRATION, CHEST PHYSIOTHERAPY, SUPPORTIVE, COUNCIL RELATIVE THE WORST OUTCOME, LET'S HOPE FOR THE BEST, BEST OF LUCK

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It's frontal depressed fracture with base of skull fracture with DAI. Prognosis is very poor. Continue conservative , poor pronosis is to be explained.

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Brain injury + ICH+ fracture of frontal bone causing mass effect....so there are chances of increase swelling further..leading to further damage.. Pupil non reactive + dilated... compression of optic nerve + chiasma...means pressure effect or herniation. Neurosurgical opinion would be best. Also patient is young, so brain occupying whole skull space.. so after swelling further brain compression may b possible. After sx... there are less chances of recovery, may lead to complications + need to keep under observation post sx...but it will take long time for maintaining....doing surgery would be only for life saving purpose with poor prognosis. Death may occur early or on the OT. table After explaining whole scenario to relative.. if they still are ready to continue treatment & wait & watch.. Then treatment protocol can be proceed further "signing all necessary consents paper and documents ".

RTA RELATED HEAD INJURY RESULTING IN BRAIN INJURY HERE WE HAVE TO SEE FOLLOWING PIONTS AY SKULL FRACTURE INTRAVENTRICULAR HEMARGHE SUBDURAL HEMATOMA IF THEIR IS S D H WE HAVE TO DRAIN IT ARE TEIR ASSOCIATED INURES LIKE CHEST ABDOMEN OR ANY OTHER FRACTURES USUALY IN SUCH TYPES OF SEVERE BRAI INJURIES WITH FIXED DILATED PUPILS PT UNRESPONSIVE PROGNOSIS IS GUARDED

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41yrs/M H/o severe trauma to head,GCS 4/15,dilated pupils non reactive to light, Hypotension and bradycardia. CT scan head shows multiple skull fractures,internal bleeding and edema and midline shift and compressed ventricles,indicating tentorial herniation that presses midbrain and brain stem,causes haemodynamically instability.PATIENT IS IN VEGETATIVE STATE

Multiple depressed fracture in skull.. With hemorrhagic confusion Although current gcs is low, but young pt should always given a try Must do necessary intervention specially by neurosurgery for depressed fracture need to do decompression at least for now All necessary measure, like early tracheostomy, air bed, etc

Depressed frontal skull bone#at multiple sites with temporal bone Lacerated brain tissues with ICB (spillage n oedematous) at the left fronto temporal region with midline shift to right. Poor prognosis.

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