Concluded Case

TRAUMATIC BRAIN INJURY

NEW CASE -30yrs old male presents by EMS post MVC.According to EMS,The Patient drove off the road into a grove of trees.Intubated and mechanically ventilated upon arrival to emergency due low GCS and agonal respiration. O/e - Unconscious,extensor posturing of all extremities.Gasping,Pupils - B/l 6mm NRTL,GCS - E1M3V1,Chest - Aspirated,Abdomen - Soft,Non tender,BP - 140/90mmhg,PR - 72/Mt,RR - 32/Mt,Temp - 102°F on presentation.Antipyretics and cooling wraps were initiated to control the fever,His fevers persisted with marked fluctuations despite antibiotic therapy. Lab values -Hb - 14, TLC - 28,000,Na - 150,K -2.2,LFT-Normal,Raised urine output. Present status - Unconscious on ventilator support,Pupils - Right 6mm NRTL,Left - 4mm SRTL,Temp - 102°F.NEURSURGEON EXPLAINED PROGNOSIS TO RELATIVES. DIAGNOSIS AND APPROACH PLEASE??

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Concluded answer

Hemorrhagic contusion rt frontotemporal with severe brain edema with midline shift to left side with severe trans false and uncal herniation to left. There is intraventricular extension of blood to both lateral,3rd and 4th ventricle.Sulcal blood left frontal and parietal areas suggestive of minimal SAH.Fracture rt temporal bone with subgalial hematoma. Prognosis seems to be poor. Rest left with Neurosurgeons opinion

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Hemorrhagic contusion rt frontotemporal with severe brain edema with midline shift to left side with severe trans false and uncal herniation to left. There is intraventricular extension of blood to both lateral,3rd and 4th ventricle.Sulcal blood left frontal and parietal areas suggestive of minimal SAH.Fracture rt temporal bone with subgalial hematoma. Prognosis seems to be poor. Rest left with Neurosurgeons opinion

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Traumatic contusion Rt FrontoTemporal area with multiple hemorrhagic areas and intraventricular extension.... Aspiration pneumonitis with fever and such a poor GCS....Neurosurgery intervention

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Global severe parenchymal damage, add on respiratory compromise by aspiration pneumonia, very poor GC on presentation...all grave prognostic indicators

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Diffuse injury with IVH with aspiration pneumonitis. This is DAI grade 3. IVH in trauma itself is a poor prognostic factor. Also GCS is low at admission. Poor prognosis to be explained. Continue conservative management

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Right fronto temporal with haemorrhagic contusion with with right lateral ventricle injury and intraventricular haemorrhage into lateral, 3rd and 4th ventricle with global severe parenchymal damage with significant midline shift and fracture right temporal bone Considering poor prognosis neurosurgical intervention will not help much except add to the,cost of treatment. . Continue ventilatory support and conservative treatment

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Rt acute hemorrhage followed by ventricular fracture already on ventilation with low gcs score prognosis not good however please still include NSX for their opinion...

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Rt frontal bone fracture with frontal hemorrhagic contusion, with ivh with midline shift May required rt fronto temporal decompression as gradually due to edema icp will raised or atleast EVD will help to drain blood from ventricle and will reduce icp Pt is young must be consider for surgical intervention earliest with guarded prognosis

Rt frontal hemorrhagic contusion with ventricular breakthrough with fracture

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Acute hemorrhage RT, followed by ventricula fracture.. Very poor prognosis.

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