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Journal of Neurology and Clinical Neuroscience | Volume: 03
8
th
International Conference on
NEUROLOGICAL DISORDERS,
CENTRAL NERVOUS SYSTEM AND STROKE
&
International Conference on
NEUROLOGY AND NEUROSURGERY
December 04-05, Dubai, UAE
Joint event on
J Neurol Clin Neurosci, Volume: 03
Early decompressive Craniectomy in Subdural Hematoma and good outcome – Case
report
Richam Faissal El Hossain Ellakkis
Hospital Municipal Padre Germano Lauck, Brazil
Case Report
: A 20-year-old man presented to our Hospital
with severe brain trauma, hit by a car while he was riding a
bike. On the arrival at the emergency roomhis GlasgowComa
Scale (GCS) was 4 (eyes 1; verbal 1 and motor 2) with fixed
midriatic pupils and submitted to mechanical ventilation. A
CT scan was performed and revealed a subdural hematoma,
midline shift greater than 5mm and a swelling, Marshall
V (surgically evacuated). The patient was submitted to a
decompressive craniectomy and hematoma evacuation two
hours after the accident and sent to ICU with ICP monitoring.
About 48 hours after surgery a new CT scan was performed
and revealed a good outcome and then we suspended the
sedation and 7 days after the trauma the patient woke up
without neurological deficits. Currently the patient is doing
his last year in the Faculty of Biomedicine.
Discussion
: Some authors did not see benefits in early
surgery although the average time was 5 hours after
the accident and in many cases the worse patients that
underwent to early surgery had a poor outcome. We did not
find a specific paper describing the outcome in patients with
a very poor GCS ( less than 5 ) and fixed pupils, although the
pupils abnormalities remains a critical feature for surgical
indication.
Conclusion
: We believe that even in patient with severe brain
trauma, poor GCS and non-reactive pupils, early surgery
especially if it is performed before 4 hours can probable
improves the outcome, considering other clinical features
such as blood pressure, oxygen saturation.
Biography
Richam Faissal El Hossain Ellakkis has completed his graduation in
Medical School at the Federal University of Mato Grosso do Sul and the
residence of Neurosurgery at Hospital de Base, São José do Rio Preto.
Fellowship in Skull Base Tumors and Neurovascular at University of São
Paulo. At present living in Foz do Iguaçu in the position of Neurology
and Neurosurgey Coordination at Hospital Municipal Padre Germano
Lauck.
e:
richam_e@hotmail.com