Concluded Case

SDH Rt frontoparieto- temporo- occipital with poor prognosis

New case. 84 yr ,M, Admitted with the history Alleged fall at home on 3ed Dec at 18:30 hrs. While getting up from his chair he fell down. Arrived at the hospital on 4th at 11AM due to low GCS. Recently recovered from COVD 19..Known DM,hypertensive ,old stroke, late onset seizure,hypothyroidism and early park. On multiple drugs for the underlying disease including Clopidogrel and Ecosprin. On exam at ER: GCS E1 V1 M3.Residual old stroke spasticity rt side.Bp140/ 70 mmhg. Admitted under Neurosurgeon after discussing the poor prognosis.Family was not willing for aaggrassive management.On mechanical ventilator and today agreed for evacuation the bleed. What abnormality in theCT brain and how is the prognosis?

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Thanks for all answeres. Discussion.what abnormality in the Ct with prognosis. Prognosis - Extremly poor, pt is still in the Neurosurg ICU,tracheostomy done. CR brain : SDH noted along Rt fronto parieto- temporo- occipital convexity ,with maximum thickness32.2mmalong the Rt frontal convexity. Few small hypodensities noted with in the SDHin the anterior aspect. There is mass effect in the form of effacement of bilateral hemispheric sulci( R > L ) with significant midline shif towards the left side measuring 16 mm. There is uncal herniation with ,compression and rotational deformity of midbrain. Effacement and compression of Rt lateral ventricle predominantly frontal,occipital horn and atria.

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Thanks for all answeres. Discussion.what abnormality in the Ct with prognosis. Prognosis - Extremly poor, pt is still in the Neurosurg ICU,tracheostomy done. CR brain : SDH noted along Rt fronto parieto- temporo- occipital convexity ,with maximum thickness32.2mmalong the Rt frontal convexity. Few small hypodensities noted with in the SDHin the anterior aspect. There is mass effect in the form of effacement of bilateral hemispheric sulci( R > L ) with significant midline shif towards the left side measuring 16 mm. There is uncal herniation with ,compression and rotational deformity of midbrain. Effacement and compression of Rt lateral ventricle predominantly frontal,occipital horn and atria.

Subdural haematoma Cerebral oedema Hydrocephalus Midline shift to left Sh from rt frontal to occipital region Intubate If urgent intervention not done Hypoxia will occur Already gcs not good sign Mri of cervical spine Ns drip stop aspirin Opinion of neurosurgeon Prognosis bad

Rt sided homogenous semilunar shaped opacity, likely to be acute SDH with mass Effect and herniating to opposite side. Also the lateral ventricle on left side seems to be dilated. Old age with prior stroke and associated cerebral atrophy and delay in Hematoma evacuation, all leads to poor prognosis.

Even on ventilator a chance of twist drill burrhole drainage of sdh may be done.

Must give a trial for evacuation of sdh with guarded prognosis.

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