RTA HEAD INJURY : BRAIN ATROPHY OR CHRONIC SUB-DURAL COLLECTIONS

1. A CASE PRESENTATION

2.  Mr. MHS, Saudi, male, aged 70
brought in ER on 09/07/1435 with
history of RTA, His car was overturned
 Complains of headache/pain in the
neck/ no definite history of loss of
consciousness/ no vomiting.
 P/H: No history of Hypertension/DM
 Had previous RTA one year back which
he revealed later.

3.  Patient was conscious but drowsy and
confused, GCS 14
 INJURIES: Extensive lacerated wound
right parietal region of scalp and right
side of the neck.
 Small lacerated wound right hand and
right elbow.
 CHEST: good air entry both side,
suspected fracture right clavicle no
evidence of hemo/pneumothorax.

4.  ABDOMEN: Soft and lax, no
distension, no tenderness or
rigidity, normal bowel sound.
U/S Abdomen: NAD
 CNS: Conscious but drowsy and
confused, GCS:14 can move all
his limbs, No neurological
deficit.

11.  XRAY CHEST: shows fracture of second rib
on right side, most likely old fracture.
Fracture right clavicle this also may be old.
No evidence of hemo/pneumothorax.
 XRAY PELVIS:NAD
 XRAY CERVICAL SPINE: Shows sub-laxation
of C5/C6 vertebra, may be old also.
 PATIENT WAS SENT TO MOHAYEL FOR
URGENT CT BRAIN AND CT CERVICAL SPINE

15. CT REPORT:ATROPHIC BRAIN
CHANGES,
CERVICAL SPINES: MARKED
DEGENERATIVE SPONDYLOTIC
CAHANGES/MARGINAL
OSTEOPHYTIC LIPPINGS/
NARROWING OF DISC SPACE C
5/C6

16.  Hb: 12.4 WBC:11.5
 CREA: 0.8 AMYLASE:38
 AST: 35 ALT: 20
 ALP: 50 ALB: 3.5G
 RBS: 107

17. RTA/HEAD INJURY/GRADE 2
DISLOCATION OF C5/C6
VERTEBRA/ FRACTURE RIGHT
CLAVICLE ?OLD/ FRACTURE
2nd RIB RIGHT SIDE ?OLD

18.  Patient was admitted in ICU
 Treatment given: Cervical collar
 IV Fluids/Inj VELOSEF/Inj Paracetamol/
 Inj Phenytoin
 FAX sent to Neurosurgeon,ACH
 Patient gone to ACH for Neuro-
surgical evaluation on 14/07/35

19.  NEUROSURGEON REPORT:
 CT Brain: NAD
 CT C.Spine: Degenerative
changes, Cord not compensated.
 Advised: Conservative
management
 Neck Collar for 6-8
weeks

20.  Patients consciousness level
improved, but he was not able to sit or
stand.Can move all his limbs.
 Not willing to go home at all/ Even the
attendents refused to take him home.
 REPEAT CT BRAIN AND CERVICAL
SPINE WAS ADVISED

23.  Dilated extra-axial fronto-
parietal spaces ??chronic sub-
dural collections ?brain atroph
 Grade 2 dislocation of C5/C6
Vertebra, Spondylo-
degenerative changes

24.  Another FAX was sent to
Neurosurgery unit to review the
case on 22/07/1435 as patient
was still unable to walk.
 After much struggle, the patient
was accepted for review and
patient was sent on 30/07/1435
and he was admitted there.

25.  After about two weeks I found
my patient walking near our
OPD, He was in ACH for few days
and he was treated
conservatively!
 Still the dilemma remains about
exact diagnosis of the case!!!