A 24 old male, after road traffic accident , he had a head injury and loss of conciouseness 24 days ago.. Brain CT at the first day shows only small amount of sudural heamorrhage , not significant for surgical evacuation , after 7 days and till the day 24 of his ICU admission , he developed a sudden TONIC CLONIC generalized fit , we start carbamazepine tablet 200 mg once a day, we increased up to 400 mg twice aday, then no response , we added continues infusion pump sedation at the ICU and we start adding adjuvant therapy and we tried to decrease the sedation with the add of the adjuvants, we added revotril 4 mg twice aday, then we added speaking 500 mg twice aday,
Also we couldn't stop the continuous sedation ..we decided to do another brain CT SCAN
WE FOUND A BIGGER THAN HIS FIRST SUBDURAL heamorrhage , but today it was hemolysed blood collection also at the right parieto/temporal
Side...
Why brain CT delayed?
Is the brain secondary insult by pressure effect of the sudural is perminant damage snd the patient will be on that anti epileptic post surgical evacuation!??
Is this an urgent case to do burr hole evacuation under GA!??
Why the surgeon dose not follow up the midical situation and connect his new changes and investigate accordingly?
All these question I say it...
To improve our way of processing our patients
And to be honest that the surgeons defect in follow up is as much important as the surgery itself.
Respects.
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