Case of the day

TRAUMATIC IPH WITH IVH

30yrs/M presented to emergency department in Unconscious and gasping state with H/o Motor vehicle collision(Bike vs Bike) with no helmet while driving.driving. He had loss of consciousness after injury.There was no evidence of external injury over scalp. There was no history of alcohol intake at the time of intubated and mechanically ventilated upon arrival to emergency.NEUROSURGEON HAS SEEN THE CASE AND EXPLAINED POOR PROGNOSIS TO RELATIVES. Chief Complaints Motor vehicle collision Vitals BP - 110/70,HR -48,Spo2 -88% on room air,RR -32 Physical Examination Unconscious,Moving Right upper and lower limb,Left sided hemiparesis present,GCS - E1V1M3,Chest - B/l Full of crepts,Pupils - B/l Dilated fixed non reactive Diagnosis DIAGNOSIS? Management MANAGEMENT PLAN?

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A case of traumatic intra- cerebral haemorrhage- right temporal region with extension of bleed in the lateral ventricle, gross,midline shift to left , diffuse cerebral oedema. Considering a a low GCS ,neurological status and CT findings- prognosis remains poor Treatment- For the time being conservative with IV mannitol , AED'S, ventilatory support, IV fluids. If GCS - improves- decompressive craniectomy may be considered

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Huge intra cerebral hemorrhage on rt side in tempo parietal lobes leakage in rt superior ventricles and substentia nigra and hypothalamus Mid line shift Yes poor GCS pt is unconscious and nonresponsive Pupils are dialated and nonreacting to lighpt is hypoxic hence continue intubation and ventilator support Inj dexamethasone inj Ceftriaxozone Inj lasix Inj manitol Monitor vitals Chest xray to see likely hemothorax Keep neurosurgeon in loop

Sol in rt cerebral artery & rt thalamic area Acute bleed Midline shift to left Hydrocephalus Mri spine Opinion of neurosurgeon Ns drip intubation Unconscious

Bad prognosis.intubate reduce icp.ich with intraventricular extension dvd may be kept&if condition improves decompressive craniectomy as last resort

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Intracerebral hemorrhage rtFp area Ventricular haemorry Cerebral oedema Cont life supp mangment

Acute bleed with ventricular breakthrough with mid line shift pl rule out hypertension

Hemotympanum, hemosinus. It’s possible to treat hemiparesis and regain some strength to the weakened side of your body. Hemiparesis treatment is comprehensive and requires an entire medical team. Your treatment plan will likely include a combination of physical therapy occupational therapy rehabilitation therapy mental health therapy Following are some treatments that may help with recovery. Modified constraint-induced movement therapy (mCIMT) In this therapy, your stronger side is slightly restrained, forcing your weaker side to compensate. It can help strengthen those muscles. In one small studyTrusted Source of 30 people, participants recovering from stroke saw improvement in their mobility after 4 weeks of this therapy. Another studyTrusted Source found that mCIMT led to only minor improvements in people with hemiparesis. More research is needed. It’s important to work with your medical team on various approaches. Some researchTrusted Source suggests that mCIMT works best when combined with other therapies. Electrical stimulation During electrical stimulation, your physical or occupational therapist attaches small electrical pads to your weaker extremities. They send small electrical charges through the pads to make your muscles contract. Over time, this therapy can train your muscles to become stronger again. electrical stimulation may help improve gait in people with hemiparesis. Other studiesTrusted Source show improvement in people who received electrical stimulation in addition to kinesiotherapy, a rehabilitation technique that uses exercises to improve strength, endurance, and mobility. Additionally, kinesiotherapy is generally more effective when used with electrical stimulation. Mental imagery Your imagination can actually train your brain to succeed. For example, you can imagine yourself winning a race or rocking a presentation to improve your performance. You can do the same to treat hemiparesis. By visualizing yourself using your weaker side, you send nerve messages to your brain that your weaker side is strong again. A review of studies on mental imagery for hemiparesis found the treatment to be effective for regaining strength in the arms when combined with conventional therapy. Researchers noted that mental imagery may be less effective for regaining strength and mobility related to gait, however. More studies are needed, but visualization is a relatively safe treatment that may help when used with more conventional treatments. Unconsciousness is the state in which a person is unable to respond to stimuli and appears to be asleep. They may be unconscious for a few seconds — as in fainting — or for longer periods of time. People who become unconscious don’t respond to loud sounds or shaking. They may even stop breathing or their pulse may become faint. This calls for immediate emergency attention. The sooner the person receives emergency first aid, the better their outlook will be. If unconsciousness is due to low blood pressure, will administer medication by injection to increase blood pressure. If low blood sugar levels are the cause, the unconscious person may need an injection of glucose or something sweet to eat. Medical staff should treat any injuries that caused the person to become unconscious.

Intra cerebral haemorrhage in right temporal region Poor prognosis... Rx inj mannitol 100 mg TDs Inj dexa 4 mg TDs Inj meropenam 1 GM bd Inj pan 40 mg bd,inj emeset 4 mg TDs Inj lasix 20 mg stat then SOS Mechanical ventilation support.. Monitoring bp,pr spo2, pupils, power

Large acute parenchymal bleed involving right frontoparietal region, ventricular hemorrhage in all 4 with mild hydrocephalus, basal cisternal bleed, midline shift to left, cerebral edema.