Concluded Case

SEVERE TBI

38yrs old male badly injured in MVC(Bike vs car) on 6/2/20 evening presented to casualty one hour after RTA.Patient was intubated, sedated and mechanically ventilated due to low GCS(E1M2V1) as per standardized protocol. O/e - DTRs Hypoactive,Plantars 0,Pupils - Right 7mm NRTL,Left 4mm RTL.Bp - 170/100mmhg,PR -62/mt.Urgent evacuation of hematoma by Right FTP decompressive Craniectomy with loose duraplasty and bone kept in abdomen muscle was done by NEUROSURGEON.GCS improved to E1M3Vet immediate post op.Pupils - Right pupil size decreased 5mm NRTL,Left 4mm RTL.Tracheostomy and CVP done.INTERPRET CT HEAD BRAIN WITH PROGNOSIS AND OUTCOMES?

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Concluded answer
A right sided traumatic acute subdural hematoma frontotemporal region with underlying hemorrhagic contusion, gross midline shift towards opposite side. A timely surgical evacuation of hematoma,will have a favorable outcome as evidenced by improvement in G.C S . Yet another example how early evacuation of hematoma in EDH and SDH can save an important life before serious uncal herniation occurs
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Gcs is worse than the size of hematoma..So it is primarily dai.. poor prognosis ..as per your details it is one month old injury case? So what is current state
A right sided traumatic acute subdural hematoma frontotemporal region with underlying hemorrhagic contusion, gross midline shift towards opposite side. A timely surgical evacuation of hematoma,will have a favorable outcome as evidenced by improvement in G.C S . Yet another example how early evacuation of hematoma in EDH and SDH can save an important life before serious uncal herniation occurs
Rt sided parietal Subdural Haematoma with midline shift and compression of Rt lateral ventricle. Prognosis guarded. Needs medications to prevent rise in intracranial pressure. MRI Brain suggested. Antibiotic coverage. Weaning off from Ventilator as GCS and Vitals improve. Routine blood examination suggested.
Rt. Sided SDH with slight midline shift, please provide post op scans to come to a conclusive prognosis, however since the GCS has improved after post op the prognosis look compelling...
Sir,Acute SDH
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Rt ubral and sbaachnoid hemorrhage with mass effect with mid line shift

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