Pop the Top

The girl who was hit by a car a couple weeks ago was finally identified. It turns out she has some psychiatric issues and has been known to distance herself from her family for long stretches of time. A detective finally was able to locate her family, and they were obviously very distraught to find out what had happened to her. Her condition continued to deteriorate earlier this week, with the pressures in her skull rising to very dangerous levels due to the continued swelling in her brain and resultant seizure activity. A few days ago I examined her in the morning and noticed that she had what we call in doctor speak "blown pupils." This means that her pupils had become maximally dilated and did not constrict when light was shined in them. A blown pupil is a sign that pressures in the brain have reached near lethal levels. We emergently called the Neurosurgeons who took her to the operating room to do a craniectomy or in other words "pop her top." This means that they removed a portion of her skull to allow the swollen brain room to expand. The piece of skull is either stored in a refrigerator or in the patient's abdomen and can be replaced at a later time if the patient recovers. Unfortunately her prognosis at this point is very poor. But we averted death by picking up on her blown pupils and taking her to the OR.