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28-JUNE-2025 MUHAMED SAADI AQEL
26 YEARS RTA HUGE FRACTURE WITH DEPRESSED RIGHT
TEMPORO-PARIETAL BONE AND FIXED DILATED RIGHT PUPIL.
Anamnesis
The patient was transferred from other hospital
in ventilator after RTA with huge depressed
fracture right temporo-parietal bones with fixed
dilated right pupil. The referring protocol
telling that he had GCS 6/15 before intubation.
On examination, the patient is in ventilator
with right dilated fixed pupil and left sided
hemiplegia.
CT-scan done at the referring hospital showing
the huge depressed fracture, for what he was
urgently sent to the operating room.
C-shaped incision around the
boundaries of the depressed fracture and the
fragments of the depressed fracture were
elevated step-wise, so as to avoid damage to the
underlying dura. The epidural hematoma was
removed and dural was glistening and no signs of
local tear and regained cardio-pulmonary
pulsation. The fragments were returned back and
not fixed to help the brain expansion in case of
possible post-surgical brain edema. Routine
closure of the wound with Ready-Vac 12 under the
skin.
The patient was sent to ICU
to keep in ventilator.
FOLLOW UP
The right pupil still fully dilated fixed, but
the left sided paraplegia start to recover the
next day.
Comments
The fractured right temporo-parietal bone
was the major cause of his conning sign and urgent
decompression was the only solution.
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