VishwaRaj

RTA with Traumatic Brain Injury

A 21 Y young student who was preparing for Chartered accountant Exam, sustained a Road traffic accident, threatening his life and career.

Case Scenario

A 21 Y young male going on Bike met with a head on collision with 4 wheeler on Pune – Solapur highway. He was brought to VishwaRaj Hospital on 23/01/2019 in an extremely critical condition. He was unconscious, bleeding from the mouth, blunt abdomen and pelvic injury, respiratory distress, GCS Score of 5.

Patient Management at Emergency Department

Patient was thoroughly examined by trauma team of consultants and various
required investigations were done to arrive at a provisional diagnosis within few
hours of his admission in hospital.

Emergency Endotracheal Intubation was done immediately on his arrival to ER.Patient was made Haemodynamically Stabilized and later all required investigations such as CT, X-Ray, Lab tests were done.

Critical Factors of this Case :

1. 20+ days on ventilator support
2. Guarded prognosis till 25+ days.
3. Disorientation till 35 days.
4. On parenteral nutrition support 60+ days.
5. Aggresive physiotherapy for 8 months.

Patient Management at Intensive care unit

Patient had to stay for 40 days in intensive care management for his clinical recovery.

DAY 1-26 in ICU :

Patient was admitted under joint care of Neurosurgeon, Intensivist, ENT and other required clinical expertise.

Diagnosis –

1. Diffuse Axonal Injury With Right Temporal Contusion & Midline Shift Of Brain
2. Fracture & Displaced Pubic Ramus

Plan of Treatment / Surgery Performed –

1. Right FTP Decompression Craniotomy with Evacuation of SDH
2. Contusionectomy with Duroplasty done on 24/01/2019.

Post-operative, patient was shifted to ICU for intensive care with ventilator support. He was treated by various consultants as per the situation demanded. Along with continuous line of treatment, aggressive physiotherapy was provided daily by a team of physiotherapists.

Patient had to be on ventilator support for 20+ days. With great efforts by intensive care team, he was weaned off ventilator support with combined effort of physiotherapy and supportive medical treatment. Apart from prolonged ventilator support, he was running persistent fever without any etiology / pathogenesis and was under the care of Infectious disease specialist.

DAY 27-40 in ICU :

On 27 day of his admission he was taken for surgeries of
1. Cranioplasty
2. PEG insertion
Throughout his stay at hospital close intensive monitoring, Cross consultations, Aggressive physiotherapy,
and parenteral nutrition were provided.

DAY 40-65 :

Patient shifted to wards for regular management. Decanulation was done after he was Haemodynamically & neurologically stable. He was discharged from hospital after 65 days of his clinical treatment. He was bed ridden while being discharged from the hospital.

Conclusion :

On the current date patient is walking, improved orientation and able to do his activities independently

About Surgeon –
Dr. Siraj Basade
MBBS, MS, DNB(Neurosurgery)
5 Years of Working Experience

Dr Siraj Basade is a Sr. Neuro surgeon (Brain and Spine surgeon) practicing at VishwaRaj Hospital as Chief Neurosurgeon. He has undergone training in Vascular neurosurgery, Neuro trauma, Neuro endoscopy, complex Spine surgery workshops held at AIIMS New Delhi.

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    About Writter
    Department of Neurosurgery and Neurology

    VishwaRaj Hospital’s Neurosciences department, with its 2 branches, Neurosurgery and Neurology are highly competent to diagnose, operate, treat and care for all patients requiring urgent and excellent care. With our senior surgeons with more than 15 years of surgical experience to their credit have performed brain decompression surgeries with great precision in our fully equipped operation theatres.

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    VishwaRaj Hospital prides itself in providing the best services for the most critical departments.