Hi and thanks for the query,

Thanks again for attaching the paraclinical report.

The results present an acute sub Dural hematoma with some cortical hemorrhages. These are indications bleeding in the brain. Considering the fact that there is no mass effect or compression of the cerebral ventricles, has a good memory, does not present a significant neurologic deficit and is oriented in space and time make a conservative management, as adopted by his management team, rather than a surgical approach acceptable and very reasonable. With a conscious and good control of his vital parameters, monitoring of signs of intracranial hypertension, use of drugs that reduce intracranial hypertension which certainly will be the case in an intensive care unit, the outcome should be favorable. I must insist that monitoring and serious close follow-up to ascertain changes in his mental and neurologic status is a key aspect in his management.

The most preoccupying thing in his laboratory result now is the blood glucose level. It would be interesting to know exactly when he ate last or better to measure glycated hemoglobin levels to distinguish acute increase blood glucose from chronic high levels of glucose. No matter the outcome, it is very important to manage this high glucose levels he is experiencing now, for it compromises outcome, especially in intensive care patients with blood trauma. I suggest you could insist or ask your physician about what they are doing with respect to the raised serum glucose levels.

Stress could induce acute rises in SGOT/SGPT which are liver transaminases. This however needs o be controlled for later, but the impact on the outcome of the patient at this point in time is almost negligible. White blood cells are slightly above the normal upper limit but it’s not an issue to worry about now. Low Sodium levels must be managed appropriately. Fluids used in cranial trauma usually contain Sodium and should be sufficient, based on specific protocols to adjust blood Sodium levels very appropriately. Serum Cholesterol could be controlled and managed later.

Nursing is one important aspect now in his management. Considering the fact that he is lying down, it very important to mobilize him or change his position, every two hours at most to avoid onset of bed ulcers or decubitus ulcers. This also reduces risk of pulmonary emboli. Certain drugs like Low Molecular weight Heparin, Lovenox (R) are prescribed systemically in some ICUs to prevent this condition.

The mainstay in his management now is correction of blood glucose and Sodium levels, putting in place of stringent intracranial pressure reduction therapies and monitoring of the patients neurologic and clinical state. His clinical status presented now and results of the CT scan make medical treatment in an intensive care unit appropriate. I suggest you just need to be calm but cautious to ensure that monitoring of clinical and paraclinical aspects of care as I earlier mentioned are done appropriately. You need not bother for it usually takes a few days to a week or two in patients, although with differences from case to case to get back to normal.

Thanks and best regards, as I advice patience but being observant. Best regards and quick recovery for your dad.

Dr Luchuo, MD.

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Hi and thanks for the information.

I am very comfortable with the drugs he is taking. Essentially, Tramadol is to reduce any pain he might be feeling and well indicated under such circumstances for pain can cause stress. Mannitol is a diuretic that shall help in reducing intracranial pressure. Somazina is a neuroprotective agent to protect against any destructive of brain cells that could arise due to oxidative activities of hypoxia or lack of oxygen. Essentially, the others take into account his past medical history (hypertension, diabetes).

I suggest with a good follow up of his vital parameters (blood pressure, temperature, and respiratory rate), blood glucose, frequent mobilization in bed after every two hours (nursing) and neurologic follow up, considering the results of the laboratory tests, clinical condition on admission and the treatment given, he should normally recover. Thanks and I wish him the best of health and a quick recovery. As I mentioned earlier, I am comfortable with the treatment and optimistic of the outcome.

Best regards,
Luchuo, MD.

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Hi and thanks so much too for the detailed reply.

As I mentioned earlier, with stable vital parameters like the blood pressure, a good blood glucose level and with appropriate medications and nursing, I suspect that he should be fit for discharge and being managed as an out patient in at most three weeks. The evolution however differs from patient to patient. It could come earlier or a bit later.

It is based on both clinical findings and CT scan results that a decision for discharge shall actually be made. I would not mind looking at the results of the scan. I would however insist on monitoring, clinically, blood pressure and his blood glucose. The ideal would be to maintain them under these limits now. Nursing is also very important. Mobilization every two hours, moving him to avoid risk of pulmonary embolism and bed sores.

Hope this helps as I wish him and you the best of health.

Best regards,
Luchuo, MD.

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