![]() ![]() When it occurs, a fixed dilated pupil may be present in one or both eyes. A non-contrast head computed tomography (CT) scan was immediately performed and revealed a mixed density left holoencephalic subdural collection measuring 14.5 mm with a 6.1 mm midline shift, consistent with an acute-on-chronic left subdural hematoma and a. A blown, or blown out, pupil is characterized by a pupil that is largely dilated and unresponsive to light. Further prospective studies are required to determine which patients with GCS of 3, and BFDPs are likely to benefit from aggressive treatment. She became less responsive, developed slurred speech, and a blown pupil on the left. Clinicians, however, are less likely to aggressively treat BFDP patients than RP patients. These patients have suffered devastating brain injuries and tend to be hemodynamically unstable. Conclusion: Patients with GCS of 3 and BFDPs have a 100% mortality. following craniotomy for traumatic hematoma in patients with fixed dilated pupils. Despite having more extra-axial bleeding, BFDP patients were less likely to have a neurosurgical operation than RP patients. Acute subdural haematoma (ASDH) is one of the most common traumatic. Trauma system factors, however, may also have had an impact on outcome. With regard to patient factors, BFDP patients were more likely to be unstable, have extra-axial bleeding, and evidence of midline shift and/or herniation. All BFDP patients died, whereas 87% of RP patients died. In all, 100 patients were analyzed, after excluding 20 patients who were dead on arrival, and 25 others, who were intoxicated with alcohol or received paralytic agents in the trauma room. Results: During this period, 145 patients were admitted with GCS of 3, and met inclusion criteria. ![]() ![]() Demographics, injury data, prehospital times, procedures, and outcomes were recorded. Methods: We reviewed all adult, traumatic ASDH patients with GCS 3, admitted to our institution from Decemto December 31, 2017. We then determined if trauma system or patient factors were responsible for the difference in mortality. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDPs) with GCS 3 patients having reactive pupils (RPs). Published by BMJ.ABSTRACT Background: Low Glasgow coma scale score (GCS) and pupillary status predict poor outcomes in traumatic acute subdural hematoma (ASDH) patients. This case raises important questions regarding factors used to determine prognosis and surgical viability for ASDH.Ĭoma and raised intracranial pressure Neuro ITU Neurosurgery. ![]() To the best of our knowledge, this is the first reported patient with a spontaneous, regressing ASDH and prolonged BFDP who clinically improved. The patients neurologic status continued. His long-term outcomes were good: achieving independence in his activities of daily living and a GCS of 15. A comput- erized tomography (CT) scan of the patients head was performed, which revealed a large subdural hematoma. Neurological improvement and spontaneously reduced SDH thickness were observed 10 hours postadmission, and he was later transferred for craniotomy and ASDH evacuation. Emergency CT imaging demonstrated a large right ASDH and the patient exhibited BFDP for >3 hours despite sedation and mannitol. We present a mid-60s man, found unconscious, with a Glasgow Coma Scale (GCS) of 4 following 8 days of headaches. Whether patients with spontaneous ASDH and BFDP follow similar outcomes is unknown. Bilaterally fixed and dilated pupils (BFDP) in traumatic acute subdural haematoma (ASDH) patients represent an ominous sign that portends irreversible brainstem injury and death. ![]()
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