Traumatic Brain Injury - Case Study Part 1

Presenting Condition

Traumatic brain injury with intracranial bleed, skull fracture, and diffuse brain oedema.

Intubated and ventilated.

History of Presenting Condition

Sustained a traumatic brain injury following a road traffic accident on his bicycle. His bicycle was hit side on by a car, which propelled James off the bicycle and into oncoming traffic. His helmet was broken during the impact. GCS 6 at the scene and required intubation prior to transfer to the emergency room. 

Social History

James is a 43 year old computer programmer. He lives with his wife, one son and one daughter (age 9 & 12 respectively)  in a two storey house. He is a sports enthusiast, playing social 5-a-side football with work colleagues weekly, and in his spare time enjoys running and biking. He also has an interest in gaming, and in making or modifying computers and helps out at his local Coder Do Jo, where his children learn about computers.

Past Medical History

No significant past medical history.  

ORIF left radial fracture 3 years ago following fall from bicycle

Investigations

  • Mild subdural heamatoma 

  • Moderate right intracranial bleed with ventricular and peri-mesencephalic cistern obliteration consistent with a trans-tentorial herniation.  
  • Large depressed fracture right temperoparietal area and large scalp wound
  • Right clavicle fracture 
and 4th rib fracture 

  • Diffuse brain swelling

Surgery

  • Right hemi-craniectomy for removal of epidural and subdural haematoma to manage intracranial pressure
  • Left craniotomy for the placement of an external ventricular drain, which remained in situ for 14 days 
  • Tracheostomy tube placement 4 days following the accident 
  • PEG tube for nutritional support