Concluded Case

Major Traumatic Brain Injury

Alleged history of RTA bikes vs truck with out any comorbid illness. Chief Complaints Alleged H/O RTA bike vs truck on yesterday 9.45 AM. Became unconcious with ear bleed lt side.Arrived ER 10.45 AM. Vitals Bp170/ 100mmhg. Saturation 92% Multiple legs abarations also noted. Physical Examination Unconcious,E1VtM1.pupils 2mm rt,4 mmleft,both non- reactive.Absent ocular movements. Intubated and mechanically ventilated at ER.Admitted under Neurosurgeon. Investigations CT brain done ,report for discussion. Diagnosis Major TB1 Management Explained the poor prognosis to the relatives ,but the relatives are requesting active surgical management. What abnormality in the CT brain?. Discuss the management.

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Thanks Curofy and all others who answered. Discussion : What abnormality in the CT with Management. CT brain: **Diffuse,cerebral,cerebellar & brainstem edena,effacement of bilateral ventricular system,cisternal spaces& cerebral sulci. **Diffuse SAH in bilateral frontal,temporal,parietal& occipital cortical sulci,bilateral sylvian cisterns,prepontine cisterns, left mesencephalic cistern& bilateral CP angle cistern. **Acute SDH with laying of hemorrhagic component in the left fronto- temporo- parietal convexity. ** Small Rt frontoparietal acute SDH. ** Small intrsparenchymal hematoma / thick SAH in the rt occipital region. ** Bikateral temporal & anterior interhemisphric SDH. Mikd midline shift to Rt.*Mikd Sud falcine& uncal herniation to rt. Management. Extremly poor prognosis.Rlativesreq for surgery,From ER with active supportive management,Pt was shifted for Emergency left Froto-temporo-parietal decompression craniectomy and evacuation of SDH - abandoned due to cardiac arrest

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Thanks Curofy and all others who answered. Discussion : What abnormality in the CT with Management. CT brain: **Diffuse,cerebral,cerebellar & brainstem edena,effacement of bilateral ventricular system,cisternal spaces& cerebral sulci. **Diffuse SAH in bilateral frontal,temporal,parietal& occipital cortical sulci,bilateral sylvian cisterns,prepontine cisterns, left mesencephalic cistern& bilateral CP angle cistern. **Acute SDH with laying of hemorrhagic component in the left fronto- temporo- parietal convexity. ** Small Rt frontoparietal acute SDH. ** Small intrsparenchymal hematoma / thick SAH in the rt occipital region. ** Bikateral temporal & anterior interhemisphric SDH. Mikd midline shift to Rt.*Mikd Sud falcine& uncal herniation to rt. Management. Extremly poor prognosis.Rlativesreq for surgery,From ER with active supportive management,Pt was shifted for Emergency left Froto-temporo-parietal decompression craniectomy and evacuation of SDH - abandoned due to cardiac arrest

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NCCT head is showing SDH,if hess hunt score is less than active intervention can be done

VERY GOOD CASE WITH NICE EXPLANATION

Subdural bleed along bilateral frontal and left frontoparietal region with multiple hemorrhagic contusions Linear subdural bleed along bilateral tentorium cerebelli.

Subdural haematoma with multiple haemorrhagic contusions in B/L frontal and left paritel regions. This case should be managed actively both surgically and medically .

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