Validity of exploring a head-injured patient with a unilateral fixed dilated pupil: A case report

Abstract

Background: Globally, head injury is a leading cause of morbidity and mortality among the young productive age group. Expanding Extradural haematoma is potentially a life-threatening condition, and could leave a surviving patient with a life-long disability. Usually, the clinical diagnoses supported by skull X-ray showing fracture are confirmed with Computed Tomography Scan (CT Scan) when available. When CT Scan is not available but all evidence is pointing towards an Extra Dural Haematoma, can one still go ahead with the Exploration?

Case Summary: We present a 27-year-old man with a 21-hour history of Motor Vehicle Accident, loss of consciousness, Lucid interval and right hemiparesis. No seizure or vomiting. Other systems were essentially normal. His Glasgow Coma Scale score was 10/15 (EO=2, BVR=3, BMR=5). He had Left-Sided Fixed Dilated Pupil (FDP). Skull X-ray revealed a left-sided comminuted fracture involving the temporal, parietal, and occipital bones. CT Scan was not available (non-functional at the time). Based on the clinical diagnoses supported by the fracture on the skull X-ray, he had an urgent Exploratory burr hole where Extra Dura Haematoma was found and evacuated. The postoperative period was uneventful.

Conclusions: The availability and functionality of CT Scans are still a problem in Low and Medium Income countries. Therefore, an Exploratory burr hole to diagnose an intracranial haematoma and its evacuation may be valid.