Concluded Case

Major Traumatic Brain Injury

NEW CASE. 42 yr ,M, Alleged RTA on 15th ,bike vs bike. Reported unconcious and evaluated locally, intubated and mechanically ventilated and then transferred for further management. Exam at ER deeply sedated and paralyzed. BP 90/ 60 mmhg. Pupils 2 mm ,non reactive . All DTRs absent plantars0 ( physical findings -medically paralyzed state).Case was ref to Neurosurgeon and admitted in the ICU. Diagnosis,and prognosis.Our Neurosurgeon explaind the prognosis and the relatives accepted the same.

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Concluded answer

Thanks for all answeres. Patient is still in the hospital,under Neurosurgeon. Evaluated by thdopththalmologist also. Conservative management,tracheostomy done. Getting physio . * CT brain : Multiple hemorrhagic contusion both hemisphere large left temporal region. * SAH involving central sulci of both hemisphere, posterior interhemispheric region & interpeduncular cistern. * Inteaventricular hemorrhage involving bilateral lateral ventricles and 4th ventricle. * Cerebral edema ,mid line shift to Rt. * Pneumocephalus. * Multiple # ,longitudinal @ left temporal bone. * Undisplaced # floor of orbital roof. * Subcutaneous emphysema Rt periorbital,prezygomatic and premaxillary region.

All Answers

Thanks for all answeres. Patient is still in the hospital,under Neurosurgeon. Evaluated by thdopththalmologist also. Conservative management,tracheostomy done. Getting physio . * CT brain : Multiple hemorrhagic contusion both hemisphere large left temporal region. * SAH involving central sulci of both hemisphere, posterior interhemispheric region & interpeduncular cistern. * Inteaventricular hemorrhage involving bilateral lateral ventricles and 4th ventricle. * Cerebral edema ,mid line shift to Rt. * Pneumocephalus. * Multiple # ,longitudinal @ left temporal bone. * Undisplaced # floor of orbital roof. * Subcutaneous emphysema Rt periorbital,prezygomatic and premaxillary region.

Multiple bilateral haemorrhagic contusions of cerebrum with diffuse cerebral oedema,and axonal injury, global cerebral ischaemia with SAH with right lateral ventricle extension of haemorrhage NEUROSURGICAL INTERVENTION WILL NOT BE OF USE . PROGNOSIS POOR Only conservative treatment is possible with ventilatory support, decongestive therapy with mannitol., AED'S and supportive treatment

Coup counter coup type of injury Involving rt anterior temporal and left parietal area with hemorrhagic contusion and edema NSX opinion, with regular monitoring of ICP clinically and repeat ct after 24 hrs Conservative management as of now seems appreciate..

SDH with hemorrhagic infarct Intubate the patient for further management Insert RT See blood report See hemocystine See ecg See thyroid profile See 2decho N treat accordingly

Severe cerebral edema w/ right inter ventricular bleeding, left Intercerebral hemorrhage and other sporadic hemorrhaging foci, ruptured left eye globe. Poor prognosis.

SDH with multiple haemorrhagic contusion Please go for MRI for Diffuse Axonal injury Prognosis is very poor & already explained to patient attendant

Diffuse brain parenchyma damage Hydrocephalus Lacunar infarct Cerebral oedema Midline shift Opinion of neurologist