the advices you are giving, even most of the posts here are for entertainment purpose only, especially regarding real important issues. Otherwise, your post could cause unjustified emotional stress and may affect poster's decision making. The posts here is just such an exmple.
1. "A lot of edematous change in the entire brain" -- NO! Just the bifrontal and adjacent temporal lobes.
2. "Enlarged ventricles." ---- NO NO NO NO NO. If the radiology report says there is "enlarged ventricles", his/her lisence is gone. There is NO ventricular enlargment. In fact the right lateral ventricle is too small. This is because the ventricular shunt catheter is inserted from right side. And I suspect there is even little too much drain from the catheter (too aggressive decompression is not neccessarily good).
3. "Prognosis is bad"---- what are you talking about??? Patient has either coup (falling face-down) or contracoup (hitting back of head) injury to the inferior frontal and temporal lobes. This has resulted in hemorrhagic contusions and subarachnoid hemorrhage. The rest of the brain is fine and there is no herniation or midline shift. The life center--brainstem and the pons are fine so I expect patient will regain self breathing very soon. Patient will be moved out of ICU and stay couple of days on regular floor then move to rehab and d/c to home, if there is no further complications.
4. "I would call family to discuss code status." ---- code is determined when patient is admitted. Patient is only 66 and no one should dare to suggest withholding treatment as yet.
5. "The best outcome would probably be vegetative status and breath on vent for the rest of life. " ---- this is just plain irresponsible! If my resident or even fellow say things like that "based on the CT", s/he is not graduating. Period.
This is an unfortunate case but is not uncommon. Most of those cases recover largely. Patient may have mood disorders later on. Make sure ask them to look at bone window images to exclude fracture. At least they should have done MRI to look at the dead/infarcted brain area and most importantly to exclude diffuse axonal injuries (DAI) which in deed does have a bad outcome. CT should be repeated frequently (I know it is in Canada).
Did they tell you there is also right sided subdural hematoma?
Best of luck!
1. "A lot of edematous change in the entire brain" -- NO! Just the bifrontal and adjacent temporal lobes.
2. "Enlarged ventricles." ---- NO NO NO NO NO. If the radiology report says there is "enlarged ventricles", his/her lisence is gone. There is NO ventricular enlargment. In fact the right lateral ventricle is too small. This is because the ventricular shunt catheter is inserted from right side. And I suspect there is even little too much drain from the catheter (too aggressive decompression is not neccessarily good).
3. "Prognosis is bad"---- what are you talking about??? Patient has either coup (falling face-down) or contracoup (hitting back of head) injury to the inferior frontal and temporal lobes. This has resulted in hemorrhagic contusions and subarachnoid hemorrhage. The rest of the brain is fine and there is no herniation or midline shift. The life center--brainstem and the pons are fine so I expect patient will regain self breathing very soon. Patient will be moved out of ICU and stay couple of days on regular floor then move to rehab and d/c to home, if there is no further complications.
4. "I would call family to discuss code status." ---- code is determined when patient is admitted. Patient is only 66 and no one should dare to suggest withholding treatment as yet.
5. "The best outcome would probably be vegetative status and breath on vent for the rest of life. " ---- this is just plain irresponsible! If my resident or even fellow say things like that "based on the CT", s/he is not graduating. Period.
This is an unfortunate case but is not uncommon. Most of those cases recover largely. Patient may have mood disorders later on. Make sure ask them to look at bone window images to exclude fracture. At least they should have done MRI to look at the dead/infarcted brain area and most importantly to exclude diffuse axonal injuries (DAI) which in deed does have a bad outcome. CT should be repeated frequently (I know it is in Canada).
Did they tell you there is also right sided subdural hematoma?
Best of luck!
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