Traumatic brain injury resulting in brain death

Case contributed by Mr Andrew Murphy

Presentation

Fall from a ladder, isolated head injury. GCS of 3.

Patient Data

Age: 50 years
Gender: Male

Initial imaging

Modality: CT

Bilateral temporal bone fractures and intracranial haemorrhage mostly centred intraparenchymally within the frontal temporal lobes. There are further areas of subdural, extradural and subarachnoid haemorrhages throughout the brain. Evidence of sulcal effacement and narrowing of the basal cisterns.

The patient became increasingly bradycardic and hypertensive over the next two hours.

2 hours post

Modality: CT

Progression of the bifrontal and bitemporal intraparenchymal haematomas to moderate volume adjacent to the anterior cranial fossa floor.  The largest left frontal haematoma measures 34 mm (AP) x 17 mm (TV) x 10 mm (CC) and the right frontal lobe measuring 21 mm x 17 mm x 32 mm.

The layering of haemorrhage on the left tentorium in keeping with subdural haemorrhage maximally measuring 3 mm. Left temporal subdural haemorrhage measures 3 mm. 

Minor progression of the bilateral  hemispheric subdural haemorrhages.  No intraventricular haemorrhage redistribution.  However haemorrhage is present within the prepontine cisterns.
Progressive effacement of the cisterns is noted with no evidence of uncal or tonsillar herniation.

The intracranial pressure became harder to deal with over the next two days 

2 days post

Modality: CT

There is an interval increase in the size of the intraparenchymal haematomas of both of the frontal lobes. 

There is now a new small subdural haematoma over the clivus 

Still no evidence of transtentorial or cerebellar tonsillar herniation.

Cerebral blood flow study

Modality: Nuclear medicine

There is an absent intracranial perfusion and tracer uptake in keeping with brain death. Hot nose sign noted. 

Case Discussion

Ladder related trauma such as this one are increasing, there is increasing research that suggest ladder related injuries and mortalities are on the rise, believed to be a result of an aging population and a do it yourself  attitude to domestic labour. The at risk group are males over the age of 45 1,2.

 

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Case Information

rID: 48591
Case created: 16th Oct 2016
Last edited: 16th Oct 2016
Inclusion in quiz mode: Included

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