Concluded Case

A case of major head injury

New case 47 yr,M, Alleged RTA,Scooter with car.Payient being rider was thrown out of the vehicle, sustained injury to head. Evaluated at Govt Medical College ,intubated and ventilated due to low GCS and then transfered. On exam on sedation ,medically paralysed. BP 100/ 60 mmhg. E1VtM1.pupils 2mm nonreacting. All DTRs hypoactive. Patient is under Neurosurgeon, in the Neurosurgery ICU. What abnormality in CT brain ?. What about the prognosis ?

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Thanks for the answeres. CT brain- * Hyperdense EDH Rt frontoparuetal region. * Hyperdensr SDH along Rt occipito temporal convexity . * Multiple intrapatenchymal hematoma in the bilateral temporal subcorticsl and deep white matter with perilesional edema. *Hyperdense SDHin left fronto temporal convexity. * Intraventricular hemorrhage. * Midline shift to rt . *SAH in the interhemispheric fissure bilateral ambian cisterns,interpeduncular cisterns and Rt crural cistern.. * Bilateral uncal herniation Lt > Rt. Craniotomy Bilateral,frontotemporoparietal EDH and SDH removed after discussing with the relatives and explained poor prognosis Relatives opted for surgery pt is on ventilator ,in the neurosurgery ICU.

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Thanks for the answeres. CT brain- * Hyperdense EDH Rt frontoparuetal region. * Hyperdensr SDH along Rt occipito temporal convexity . * Multiple intrapatenchymal hematoma in the bilateral temporal subcorticsl and deep white matter with perilesional edema. *Hyperdense SDHin left fronto temporal convexity. * Intraventricular hemorrhage. * Midline shift to rt . *SAH in the interhemispheric fissure bilateral ambian cisterns,interpeduncular cisterns and Rt crural cistern.. * Bilateral uncal herniation Lt > Rt. Craniotomy Bilateral,frontotemporoparietal EDH and SDH removed after discussing with the relatives and explained poor prognosis Relatives opted for surgery pt is on ventilator ,in the neurosurgery ICU.

Occipital lobe and bilateral parietal lobe Subdural hematoma and multiple intraparenchymal bleed,treatment is a Craniectomy, prognosis vegetative state.

Prognosis poor Bleeding in ventricles Midline shift right Unconscious Mri spine Opinion of neurosurgeon Prognosis poor Craniotomy

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Diffuse injury , if m1 nothing can be done continue conservative treatment, decompression if motor movement present

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Poor prognosis. Less chance for survival.

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