Concluded Case

Major Traumatic Brain injury with Poor prognosis

New Case 50 yr old ,fisherman by profession,brought to ER with Alleged history of head injury. The rope connecting the boat to J CB cutt off while pulling the boat to shore and the iron hook hit over the rt eye and rt side of face around 2.30 PM on 20th February near a beach at T Nadu.H/ o of loss of conciousness ,vomited once with bleeding ear ,nose and mouth . Evaluated at Medical College TN,and then transferred to a Neurocenter .Level of conciousness was documented as E1 VT M1 and intubated and mechanically ventilated and then ref to our ER. At Er BP was 120/ 68 mmhg,Rt eyeball was projecting out side,left pupil 4 mm,non reacting .Sutured wound 5 cm noted in the rt forehead. At ER , he was evaluated by the ,Er team,Neurosurgeon, ENT surgeon and Ophthalmologist and the whole team discussed about the management and prognosis. Due to financial constraints, the relatives req to transfer to near by Govt Medical College and hence discharged. what abnormality in the Ct Brain and what is the prognosis?.

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Concluded answer
Thanks for all answers. Ct brain : Rt fronto parietotemporal & occipital SDH along with anterior interhemisphric and tentorial SDH. * SDH is seen dissecting in to the Rt parietal & temporalregion. * Multiple foci of intraparenchymal hematoma in the Rt parietal & temporal region. * Significant midline shift to left side. * Rt orbit is not visualized with significant hematoma, soft tissue injury& Comminuted # wall of Rt orbit suggestive of complete Rt orbital rupture. * Hematoma rt ethmoid ,frontal & maxillary sinusus Prognosis. patient was transferred to Govt MCH and expired on the 2nd day
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Thanks for all answers. Ct brain : Rt fronto parietotemporal & occipital SDH along with anterior interhemisphric and tentorial SDH. * SDH is seen dissecting in to the Rt parietal & temporalregion. * Multiple foci of intraparenchymal hematoma in the Rt parietal & temporal region. * Significant midline shift to left side. * Rt orbit is not visualized with significant hematoma, soft tissue injury& Comminuted # wall of Rt orbit suggestive of complete Rt orbital rupture. * Hematoma rt ethmoid ,frontal & maxillary sinusus Prognosis. patient was transferred to Govt MCH and expired on the 2nd day
Fracture of lateral orbital wall, fracture of inferior orbital rim, periorbital edema. The contour of the eyeball is lost, probably has a ruptured globe.
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DIFFERENTIAL DIAGNOSIS Extra dural hematoma Intracranial space occupying lessions Subdural haemorrhage
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Orbital fracture with hematoma and globe injury
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