Abstract
It is prudent to have early diagnosis and timely management of uncal herniation for better management of neurosurgical patients. There are several clinical and radiological armamentarium that aid in early recognition of the condition. Through this case report, we try to highlight a simple bedside clinical sign that can help in early recognition of the impending uncal herniation. The improvement in the sign also confirms the resolution of the mass effect in the postoperative period. This is especially helpful for doctors working in the periphery or in resource restrained areas, for a timely referral of the patient to tertiary centre.
Highlights
Traumatic brain injury (TBI) is a global epidemic[1]
Grant information: The author(s) declared that no grants were involved in supporting this work
On close examination, we observed that there was prominence of the forehead wrinkles on the right half of his face especially when the patient was trying to open his eyes during conversation, which we termed as frontalis sign (Figure 1)
Summary
Traumatic brain injury (TBI) is a global epidemic[1]. The prognosis of patients with head injury is dependent on many clinical parameters but one of the major determinants is the time lapsed for appropriate management[2]. We discuss one such example: Frontalis sign for detecting early uncal herniation This may be helpful for early referral of patients to tertiary care centres and for timely management of the same. On close examination, we observed that there was prominence of the forehead wrinkles on the right half of his face especially when the patient was trying to open his eyes during conversation, which we termed as frontalis sign (Figure 1). We suspected impending uncal herniation in the patient and thereby advised for an emergency computed tomography (CT) scan of the head. It revealed right sided huge temporo-parietal contusion with thin fronto-temporo-parietal subdural hematoma with features of uncal herniation (Figure 2).
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