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It was reported: "a 75 year-old patient had a traffic accident on (b)(6) 2025, with head injury and right fronto-temporo-parietal sdh (subdural hematoma) with mass effect, left fronto-parietal atypical contusion, left temporal minimal sah (subarachnoid hemorrhage), minimal brainstem contusion, right frontal sinus and nasal bone fracture, right orbital wall displaced fracted, right 3rd to 6th rib fracture, septic shock with right sided pneumonia, s/p right ftp decompressive craniotomy on (b)(6) 2025 outside, s/p peg tube insertion - (b)(6) 2025, sunken flap syndrome, s/p right ftp 3d titanium mesh cranioplasty done on (b)(6) 2025, urosepsis with septic shock, status epilepticus, paralytic ileum.Concurrent conditions were reported as: diabetes mellitus, hypertension.No family history was reported.Past medication was not reported.Concomitant medication and cosuspect medications were not reported." "on (b)(6) 2025, the patient was implanted with a codman hakim programmable valve via unknown route." "on an unspecified date, the patient presented with episode of left upper limb and lower limb jerky movement about an hour, associated with up rolling of eyeball and increased blood pressure (status epilepticus).So patient was brought and admitted on (b)(6) 2025, further management." "central nervous system on admission: glasgow coma scale - e2vtm4, pupil - b/l 2 mm reacting to light.Vital signs were: temperature - 98.8- degree f, pulse rate - 96/min, blood pressure was 130/81 mm hg, oxygen saturation (spo2) 98% at room air, respiration rate - 16/min."on (b)(6) 2025, patient gcs-e4vtm4, spastic quadriparesis and had complaint of high-grade fever.Per urethral catheter changed under sterile precaution.Ct brain was done on (b)(6) 2025, which shows post-right fronto-temporo-parietal cranioplasty status with associated artefacts - static as the previous study.No significant interval changes in previously documented chronic subdural collection along the right fronto-temporal convexity with maximum thickness of approximately 8 mm (previously measured 9 mm).Persistent external ventricular drainage tube was noted in situ with the tip in the right lateral ventricle.No significant interval changes in the degree of ventricular dilatation were noted as compared to the previous study.The maximum transverse dimension of the third ventricle in the axial plane was 18 mm (previously measured18 mm).No fresh intra-axial or extra-axial hemorrhage was seen on the present study." "from (b)(6) 2025 to (b)(6) 2025, under aap csf tapping done from left parietal shunt chamber, after subsequent 3 days csf tapping patient get improve clinically in form of improve eye opening.On (b)(6) 2025, csf (cerebrospinal fluid) total count: 32, cerebrospinal fluid glucose: 89, cerebrospinal fluid lactate: 3.43, on (b)(6) 2025, csf total count: 64, cerebrospinal fluid protein: 67, cerebrospinal fluid protein: 66, cerebrospinal fluid glucose: 58, cerebrospinal fluid lactate: 3.22, csf culture: no growth, cerebrospinal fluid glucose: 62." "on an unknown date, patient's relative explained in detail about possibility of shunt malfunction as shunt did not function properly and revision of vp shunt, so relative agreed for same.Patient supine with head turned to right left subcostal incision given shunt tubing exteriorized shunt pressure set to 50 but no csf comes out so left parietal scar opened, shunt chamber disconnected, clear csf comes out under pressure - suggestive of shunt chamber malfunction.So, ventricle cannula connected with dom valve medium pressure shunt.After connecting - free flow at csf comes out at lower end, so lower end kept in peritoneal cavity both wound closed in layers asd done.Patient shifted to recovery." "on (b)(6) 2025, patient had fever on/off, so treatment optimized by physician.(stop iv sulbacin and start iv meropenem) and get pre-op clearance." "on (b)(6) 2025, patient underwent revision of left vp shunt (converted from programmable vp shunt to vp dom valve medium pressure) done by physician, post procedure patient shifted to ward with hemodynamically stable condition.On (b)(6) 2025, ct brain was done, which shows post vp shunt revision status.Ventriculo-peritoneal shunt was seen entering through the burr hole in the left posterior parietal bone, traversing through the left parietal lobe with tip in the right lateral ventricle.Overlying mild soft tissue swelling with air trapping was seen in the left posterior parietal and left occipital regions - expected postoperative changes.Post-right fronto-temporo-parietal cranioplasty status with associated artefacts - same as previous scan.Thin strip of hypodense subdural collection was seen along the right fronto-temporal convexity with maximum thickness of approximately 9 mm.Mild reduction in the degree of ventricular dilatation was seen as compared to the previous study.The maximum transverse dimension of the third ventricle in the axial plane on the present study was approximately 16 mm (previously measured 18.4 mm).The maximum transverse dimension of the body of the left lateral ventricle was approximately 28.8 mm on the present study (previously measured 33.6 mm).Few pockets of pneumo ventricle are noted in the frontal and temporal horns of the left lateral ventricle - expected postoperative changes.No fresh intra-axial or extra-axial hemorrhage was seen.On (b)(6) 2025, csf rm shows tc 98, glucose 62, protein 79, lactate 4.33, csf cs show no growth of organism.On (b)(6) 2025, wound dressing changes under sterile precaution.From (b)(6) 2025 to (b)(6) 2025, patient stay remain un-eventful.Blood cs shows no growth of organism.On (b)(6) 2025, patient gcs - e3vt m4, left upper limb flexor response on dps, pupil - b/l equal reacting to light.On (b)(6) 2025, patient had hypotension (bp 78/60 mm hg) in early morning, so urgent shifted to icu (intensive care unit) for closed observation and further management, which was stabilized after iv fluid therapy, followed by shifted to ward in evening.Urine cs send; x-ray shows minimal pleural reaction was seen on right side.Right upper and left lung appear normal.Skin fold was seen along left lateral chest wall.Tracheostomy tube, peg and vp shunt tube are noted.Abg (blood gases) shows fo2 21, ph 7.45, po2 105, pco2 43.3, hco3 29.7, lactate 0.5.On (b)(6) 2025, routine blood investigation was done, cbc - hb 11.7, (b)(6), na+ 133, k+4.31." "on (b)(6) 2025, ct brain (p) shows post-right fronto-temporoparietal cranioplasty status with adjacent artefacts - static as the previous study.Post vp shunting status.The tract and position of the shunt appears same as the previous scan with tip in the right lateral ventricle.Near complete resolution of the previously documented overlying soft tissue swelling in the left posterior parietal region was seen.Tiny pocket of pneumo ventricle was noted in the right lateral ventricle.Resolution of pockets of pneumo ventricle in the left lateral ventricle was seen.The maximum transverse dimension of the third ventricle in the axial plane on the present study was approximately 14.5 mm, previously it measured 16 mm - further marginal reduction was seen.The maximum transverse dimension of the body of the left lateral ventricle on the present study was approximately 27 mm, previously measures 28.8 mm - marginal reduction noted.No fresh intra-axial or extra-axial hemorrhage was seen on the present study." "on (b)(6) 2025, cross reference done with physician in view of neurological evaluation and treatment optimization, where his advice eeg, which shows diffuse encephalopathy with right hemispheric sharp waves.' "patient was discharged on (b)(6) 2026." "patient advised to follow-up after 14 days and diet (peg feed - 200ml / 2 hourly, high protein diet, 6-8 gm salt / day) was suggested.Along with basic nursing care, all catheter care- daily, frequent postural changes, daily bed sore dressing, daily suction - twice a day and sos, back care, to use air bed, dvt pump, v-40 / a-60 bipap support (sos)." "the outcome of the event shunt did not function properly (shunt malfunction) was unknown."the action taken with chpv shunt (codman hakim programmable valve) medical device was not applicable.".
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