22yrs old male presented to casualty in altered sensorium condition with positive vocal response with irrelevant talks also complaining of fever for last two days,Nausea and vomittings.Mild right sided weakness. No diabetes,No hypertension.No past complaints of convulsions or seizures. O/e CNS - Confused with altered mental status Pupils - B/l 3mm SRTL GCS - E2V4M4,Plantar extensors BP - 190/80 HR - 62.Suggest diagnosis and management?? If the patient has no history of HTN and his coagulation profile is also normal then what could be reason for this haemorrhaget??



At present B.P is 190 / 80 indicative of accelerated hypertension. A case of hypertensive bleed left fronto temporal region with intraventricular extension of haemorrhage. Control hypertension with labetalol in drip. Inj mannitol , AED'S, , Oxygen support with mask. As age is young rule out renal artery stenosis.

I agree.

Conservative management with antiedema and anti epileptics. Workup for cause of hypertension, coagulation profile , platelet count, & CT angio to r/o vascular malformation. Also repeat CT after 72 hrs to look for any ventriculomegaly as there is ivh too.

Less likely a hypertensive bleed.....!!! Current by 190/80 with hr 62 suggestive to cushing reflex...!!! You can do ecg or echo to look for evidence of HTN as LVH And this site as well as age is unacceptable for bleed Once patient is stable do DSA for any aneurysm after 3-4 week , 2nd look for vasculitis As if now conservative management

Thank you sir

Less likely to be a hypertensive bleed The raised BP could be secondary to bleed Needs further evaluation As of now protect the airway if needed AEDs Cerebral decongestants BP control Avoid hypoxia/hypoglycaemia Adequate hydration Neurosurgery opinion needed Close Neuro monitoring Suggest: CT angio/DSA 2D-Echo RFTs USG abdomen Routine labs

LT frontal lobar hematoma with perforation o ventriculsr system lt lateral,3rd & 4th ventricles. Normotensive patient. Mild dialatation of rt lateral ventricle also.Rept ct after 12 hrs to see the ventricular dialatation Young pt & vasculitis screening -ve.Needs CTA/ DSA to exclde small avm/ angioma. If every thing normal spontaneous ICH is considered due to undetectable cause.Also need EEg to exclude nonconvulsive seizures in view of irrelevant talk.

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Accelerated hypertesion may be the cause slight midline shift is present pt had bradycardia with hypertension and symptoms indiacte rise in ICT As GCS was accepetable no need of intubation but provide oxygen injection mannitol to release compression symptoms prophylactic inj levipil 500 mg IV BD control blood pressure to 140 cilnidipine tab 10mg better not to give labetalol As bradycardia present NTG was not adviced but if other drugs not available start NTG And titrate manage hypertension

Thank you doctor.

Agreed with all answers. CT angio was done followed by decompressive craniotomy. No vascular malformations.

Undetected htn, may be secondary to various reasons, and drugs like cocaine Lobar bleed may be associated with cvst, mrv indicated.

Haemorrhage can be due aneurysm watch the bp inj mannitol to be started immediately before further damage is done by raised I promise Keep head end elevated ryle's tube feeding because the pt might deteriorate

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