Traumatic “Brain Stem Contusion” (BSC): Acute Presentation and Management in a Tertiary Medical Centre- A Case Report and Review of Literature

Introduction: Traumatic brainstem lesion (BSC) after head injury due to RTA (Road Traffic Accident), though an uncommon event, depends upon the high velocity acceleration-deceleration forces. It leads to rise in Intracranial Pressure (ICP) & brain herniations, resulting in change in brainstem microstructure. Focal traumatic BSL is a rather rare event. Case Description Here we present an interesting case of 35 year male presented to our E.D. (Emergency department) with two episodes of vomiting & altered sensorium, due to fall, with Glasgow Coma Scale (GCS) of E1V1M5 (7/15). There was left sided hemiparesis. Computed Tomography (CT) scan showed brain stem contusion. He was kept in Intensive Care Unit (I.C.U) for the monitoring of pulse, Blood Pressure (BP), temperature. After 17 days of conservative treatment, the patient recovered. Pt was followed up on monthly basis for next 3 months. The BSL resolved as was depicted on the repeat CT scans. Conclusion The severe morbidity and mortality associated with BSC mandates management in ICU for round the clock monitoring. This adds to the crunch of bed occupancy in any Government sector tertiary centre, but nevertheless, the outcome of such monitoring is matchless in terms of improved survival & better Quality Of Life (QOL). These cases needs further study to evaluate their future outcome. This may be the first of its kind of case report (after extensive search in Pubmed, using different relevant keywords, amongst the English literature) on this prickly issue, while choosing between catering to all & providing best available care to all.