Q for Mamboni or other Docs (Neuro?)

[beefsteak]

Fellas,
a friend of mine has just posted a statement I need to check out.

Someone is accusing a 3rd party (complete with post assault photos of contusions and other injuries sustained) of mixing up a "diabetic coma" with a coma resulting in a CAT SCAN showing blood on the brain sustained in an attack over 12 days prior to current ICU comatose state of said victim.

My question:

Is there anyway a diabetic coma shows up on a CAT SCAN as "blood on the brain?"

Thanks to any and all friendlies on here with an answer I can sink my teeth in to.

I know NOTHING about head trauma, but am wondering if this is possibly one of those "delayed subdural hematoma" deals we read about in the newspapers on occasion. But then I'd want to know if subdural hematomas also show up as blood on the brain in CATS.

I don't have much hope for the victim. Am I wrong in not experiencing much hope?

Thanks for valued input.

[Neuro]

A subdural hematoma can occur slowly if there is a small vascular injury inside the skull. I think it is fairly common in terms of hematomas. You wouldn't expect to find a hematoma in a diabetes coma patient, unless the patient fell and hit the head in connection with the coma... If the ICU was aware of a head trauma 12 days prior, they may have been negligent...

Did the patient also have diabetes?

[beefsteak]

Yes, it is reported he did have diabetes.

It is also reported and allegedly documented via a professional photographer (Hank Williams' Jr's Tour Photographer) that said comatose victim was kicked severely in the face on or about Nov 8. Criminal complaint has been filed in this matter I'm given to understand. Contusions are consistent with hard toe workboot imprint/damage to comatose victim with said CAT scan reading.

Collapse did not occur until 11/19, when victim collapsed on a recreational club outting with friends, and arrived at the hospital, comatose and hasn't roused since.

[Neuro]

Sounds to me the headtrauma is the reason, did the hospital drain the hematoma? How long after coming to the ICU was the CAT scan taken?

It is however not an unreasonable initial working diagnosis in the ICU to assume a diabetic coma, especially if the 12 day headtrauma is not that visible any longer, and the doctors didn't know about the prior head injury... But if they ordered a CAT scan immediatelly and they ignored the findings, and they don't have blood tests that show the patient was either severely hyper or hypoglycemic at admittance, then they were negligent...

[mamboni]

Difficult to know whether trauma or diabetic vasculopathy is responsible. Generally, traumatic bleeding is subdural while vasculopathic bleeding is subarachnoid. CT scan should readily distrinquish between these two types of bleed. By definition, Diabetic Coma is a severe metabolic derangement not associated with bleeding. Also, to link bleeding with an event from 12 dyas earlier is quite a stretch me thinks.

[General of Darkness]

For douche bags, you guys are kinda smart.

http://www.theinfopreneur.net/wp-content/uploads/2009/11/Dunce-hat.jpg

[learn2swim]

Any patient with an altered LOC would get a blood glucose check right off the bat. And, why would someone be in a diabetic come for 12 days? If the sugar is low, give sugar, if the sugar is high, give insulin, simple stuff. Maybe the lab results got mixed up, but then labs should been done multiple times a day for unstable patients. Sounds like someone screwed the pooch.

[beefsteak]

Neuro, Mamboni,
Thank you both for your excellent responses and in so quick a time frame. I'm learning more as the word is getting out. First off, the observable physical deterioration and marked behavioral changes since the assault was been remarkable and noticable. So noticeable and concerning in fact, the best friend was ready to intervene and take the now comatose buddy to the ER the very day when he collapsed, unconscious. He'd been slowly failing, getting confused, unable to speak or walk normally between Nov 8 and the collapse on Nov 19.

Secondly, it has been revealed that the diabetes wasn't discovered until the bloodwork up when he arrived and assessment was conducted in the ER. So it was the ER physicians that caught that.

Third, the CAT and whatever other tests they've conducted since hospitilization on the 19th have been forwarded by the attending physician himself, and volitionally to specialists in a nearby big city (Birmingham) for review and consultation.

It is truly a tragic situation, and totally uncalled for. I don't think the family and the best buddy have any sense that the hospital is operating below the standard of care or doing anything less than their deadlevel best. It's just the grief is so thick and the bereft Mother so distraught that it's hard for the non-medical family and friend support network to get their own arms around all of this, the big words, the grim diagnosis, and the shock.

They have retained legal counsel, but not to go after the hospital, but instead the attackers. And yes, the attackers are well known in the local circles, so this isn't some random violence. It was witnessed. It has been reported. This is pre-meditated and horribly effective at silencing the victim. The term, brain dead has been spoken aloud by the doctors, but the Mother simply can't bring herself to take him off life support, and the perp certainly doesn't want the victim off life support either, for obvious reasons.

Thanks again for your shared wisdom. You both really came through for me. I appreciate it.