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Large intraparenchymal bleed involving Lt thalamus ,capsule mid brain

New Case 58 yr old ,M , Known hypertensive on irregular med , admitted on 17 of this month with acute onset of vertigo ,vomiting and alteration in sensorium of 8 hrs duration. He was alright while getting up, after an he he developed head ache ,vomited and developed alteration in sensorium .Evaluated at local hospital ,intubated and mechanically ventilated and then transferred. On exam - deeply sedated on ventilator, rt pupil 5 mm,non reating ,left 2mm. Absent ocular movements. DTRs absent. plantars - no responses. Diagnosis,structures involved and prognosis.

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Thanks Dr Krishnendu for the answer. Fiscussion: Diagnosis,structures involved & prognosis. Intraparenchymal hemorrhage involving Left thalamus,internal capsule,left cerebral peduncle and left crus of midbrain with intraventricular extension . Mild subfalcine herniation with diffuse midline shift to Rt. Cerebral angio shows diffuse atherosclerotic changes in bilateral ICA with significant luminal narrowing.Tiny out touching at the junction of Rt MCA- PCOM likely prominent infindibulum/ ? aneurysm. Still on ventilator ,on active supportive management,tracheostomy today for weaning off ventilator
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ICH in lt mid brain, thalamus, IC, and IVH c hydrocephalus, old lacunar infarct in right thalamus. Prognosis grave. Evacuation may be considered. Neurosurgeon consultation.
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Thanks Dr Krishnendu for the answer. Fiscussion: Diagnosis,structures involved & prognosis. Intraparenchymal hemorrhage involving Left thalamus,internal capsule,left cerebral peduncle and left crus of midbrain with intraventricular extension . Mild subfalcine herniation with diffuse midline shift to Rt. Cerebral angio shows diffuse atherosclerotic changes in bilateral ICA with significant luminal narrowing.Tiny out touching at the junction of Rt MCA- PCOM likely prominent infindibulum/ ? aneurysm. Still on ventilator ,on active supportive management,tracheostomy today for weaning off ventilator
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