SEVERE TBI IN A 51yrs/M

51yrs/M victim of head injury in RTA arrived to the ED 4hrs after the injury,Patient condition deteriorated very quickly,The patient was intubated and ventilated. O/e - Pupils - Right 4mm NRTL,Left 8mm NRTL,GCS -E1M1V1,BP -90/60,PR - 53.Poor prognosis explained to relatives and advice surgery, Patient relatives not willing for surgery.KINDLY DISCUSS THE CASE..

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A large Extra- dural haematoma involving the left fronto temporo parietal region with significant midline shift and uncal herniation of the opposite side have already occurred Imminent brain death. Not possible to revive . This was the case - if it had been operated immediately after the injury- he would have survived as urgent burr hole evacuation in EDH give miraculous results

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There's nothing for discussion surgery is the only course and recourse Since both pupils are not dilated Its emergent. Operate right away Or refer to higher center

Leftfrontoparietal EDH with subfalcine and uncal herniation.Anterior interhemisheric bleed frontal contusion,blood in the quadrigeminal cistern suggestive of focal SAH. Suggest craniotomy with evacuation of hematoma

Even in M1 state with edh, some time sensorium improve even on ot table immediately after edh removal... Can be taken for sx after explaning risk

unfortunate bad injury..surgery only option...however, given the condition...survival unlikely even after surgery

Left EDH with hemorrhagic contusion Urgent surgical intervention

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