June 2017

64yo M found down

History 
•64yo M was found down by his landlord and taken to the hospital by EMS. On arrival he was intubated and imaging was obtained. 
•PMH is unknown
 
Examination
•T 36.0, HR 100, BP 100/60, O2 sat 100%, intubated
•Neurologically
•Opens eyes to stimulation
•Intubated
•Does not follow commands
•Localizes with the Left upper extremity greater than the right upper extremity
•Withdraws both legs
•Pupils pinpoint and minimally reactive
•Corneal, cough and gag reflexes are present

Initial Imaging Figure 1

Initial Imaging Figure 2

Initial Imaging Figure 3

Questions

References:

•Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet, 1974.
•Carney et al. Guidelines for the management of severe traumatic brain injury, 4th edition. Neurosurgery, 2016.

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