![]() ![]() While FDP without deterioration of consciousness has been described due to traumatic subdural and epidural hematomas, we report this unusual constellation as a sign of rising ICP and impeding herniation due to intraparenchymal contusions, highlighting that any pupillary change warrants prompt work-up and intervention.Ĭase report contusion fixed pupil intraparenchymal hemorrhage traumatic brain injury. His pupil became reactive 5 hours after surgery. Patients presenting with findings suggestive of cerebral insult should undergo computed tomography (CT) scan of the brain this can show the edema, which is visible as areas of low density and loss of gray/white matter differentiation, on an unenhanced image. We performed an emergent right-sided decompressive hemicraniectomy with durotomy and duraplasty. Usually, there is an altered mental status and development of a fixed and dilated pupil. Head computed tomography showed worsening midline shift and interval increase in subfalcine herniation related to increased peri-hematoma edema. Hypertonic saline and mannitol produced no improvement in his pupillary exam. Corneal reflexes were intact bilaterally. ![]() His gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to the right side. He described complete loss of vision and could not identify objects or count fingers. The patient was drowsy, arousable to tactile stimuli, answering questions, oriented to place and time, following commands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). On hospital day 8, his right pupil became fixed (NPi 0) and dilated (4.8 mm). A 58-year-old man with history of hypertension and diabetes mellitus type II presented after being assaulted, with bifrontal contusions and right frontal intraparenchymal hemorrhage. We describe an exceptional case of a patient with bifrontal contusions who developed worsening edema and a unilaterally FDP while maintaining consciousness and the ability to communicate. Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) typically experience a deterioration in consciousness. ![]()
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