A case of Major TBI with big EDH Rt parieto occipitao temporal.
New case 50 yr ,M, Pedestrian found on road side ? RTA ( hit and run) .Deeply unconcious.Bleeding nose and Rt ear. Evaluated at Govt Medical College,intubated and mechanically ventilated.Relatives arrived and transferred to our hospital. On exam ,deeply sedated and medically paralyzed. BP 100/ 80 mmhg. Pupils 2 mm,bilaterally symmetrical,poorly reacting. ALL DTRs ansent . Diagnosis ,management,prognosis
Thanks for all answeres. CT brain: * Hemorrhagic contusion with surrounding hypodensity in bilateral frontal lobes. * Similar contusions in bilateral temporal lobes with thin SDAboth sides. * Large EDH in Rt paritooccipito temporal region. * Thin SDH left parietal region,bilateral tentorial leaflets & in the flax cerebrum in high parietal and frontal regions. * SAH along the sulcal spaces of bilateral frontoparietotdmporal lobes sylvian fissures and interpeduncular cisterns. * IVH in the atrium of Rt lateral ventricle with dependent hypodensities in the occipital horns of both lateral ventricles. * Diffuse cerebral edema ,no midline shift. * Minimally displaced # rt mastoid temporal bone . Craniectomy with evacuation of hematoma done as emergency. Tracheostomy done . Patient is stable planning to close tracheostomy. On active rehab
Thanks for all answeres. CT brain: * Hemorrhagic contusion with surrounding hypodensity in bilateral frontal lobes. * Similar contusions in bilateral temporal lobes with thin SDAboth sides. * Large EDH in Rt paritooccipito temporal region. * Thin SDH left parietal region,bilateral tentorial leaflets & in the flax cerebrum in high parietal and frontal regions. * SAH along the sulcal spaces of bilateral frontoparietotdmporal lobes sylvian fissures and interpeduncular cisterns. * IVH in the atrium of Rt lateral ventricle with dependent hypodensities in the occipital horns of both lateral ventricles. * Diffuse cerebral edema ,no midline shift. * Minimally displaced # rt mastoid temporal bone . Craniectomy with evacuation of hematoma done as emergency. Tracheostomy done . Patient is stable planning to close tracheostomy. On active rehab
bilateral frontal contusion with parieto- occipital SDH neurosurgical intervention inj mannitol / hypertonic saline anti epileptic anti biotic if patient is detoriating with anisocoria , plan for craniectomy poor prognosis
New case
Frontal constusion and check eye sight occipital bone contusion check the eye and treatment continue ability of patients behaviours check then prescribe medicine
Intracerebral bleed, lower IC pressure, surgery
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