Bilateral frontotemporoparietal sub acute on chronic SDH.

The relatives noted acute onset of difficulty to communicate,in the form of putting meaningless words and sentences and inappropriate answers In a 57 yr old ,female with back ground history of DM type 2. *Chief Complaints* The husband and children noted acute onset of talking nonsense on 13 th morning onwards. Denied having any head ache,vertigo or vomiting. No seizures. No motor weakness noted by the relatives.Evaluated by the psychiatrist, and attended the OPD.I asked only one question Mam,How do you feel now and what is your problem? Immediately she answered,"walking to the shop,registered ,took bath in the shop and she laughed and finally said got fish"I replied thanks,immediately she said this is the time for lunch. . *History* Detected to be a Type 2 DM.No family history of stroke or malignancy. Non smoker. No H/ o of ethanol intake *Vitals* Afebrile BP 140/ 80 mmhg. HR 68/ mt. *Physical Examination* Fully concious. Speech fluent dysphasia ( already put the conversation in the history). Mild facial asymmetry. Motor system gr 5/ 5 . DTRS mild reflex asymmetry rtside.Plantas downgoing. She is responding to pain and while applying pain she was talking some inappropriate words also. No bruit over the carotids and vertebrals. *Investigations* Routein bloodwork up- normal. FBS 140 md/ dl. HbA1c 7%. Urine microalbuminura with in the normal limits.RFT normal Lipid profile -DLP. Dopoler neck vessels normal. MRI BRAIN DONE' keeping for discussion. *Diagnosis* Diagnosis -Very obvious in the MRI brain- keeping for discussion. *Management* Started on appropriate medicine. Including good control of DM,statin,neuroprotective,Ref to speech therapist also. Cardiac evaluation also done. DISCUSSION. What is the diagnosis?. Where is the site if lesion? What type of speech dysfunction?

62 yr old male ,presented with intractable left hemicranial head ache of 2 weeks duration. *Chief Complaints* Presented with left sided headcache of 2 weeks duration. The head ache was so severe ,starting from left tempiral region and spreading to left hemicranium almost continuous with out any nausia or vomiting or vertigo.Evaluated at neughbouring state ,took several analgesics including injections.Patient stated they he could not sleep for 2 weeks due to intolerable headache .Denied having any jaw claudication fever ,arthargia,loss of weight or appetite .Several times he was evaluated by the local physicians and all the times his blood pressure was on the higher side. He is a known case of systemic hypertension for 20 yrs and on regular med.Since two yrs ,he is on clopidogrel for CSVD. *Vitals* Afebrile,Bp 160/ 100 mmhg,no external stigmata for temporal arteritis. *Physical Examination* Optic fundi normal .Intact cranial nerves. NO FOCAL DEFICITS. NO NECK STIFFNESS *Investigations* Routein blood workup including ESR ,CRP - normal. NORMAL BLOOD BIOCHEMISYRY.MRI brain done,repirt for discussion. *Diagnosis* Final diagnosis for discussion *Management* In view of the severe head ache he received inj tramafol with phenergan.After MRI the case was ref to Neurosurgeon,and had undergone surgery on yesterday

New case 54 yr ,M, Presented with left hemicranial head ache since one week. Head ache is starting from the left occipital area and then spread to whole hemicranium.Vomited three times since1 week and last episode of vomiting today morning. Almost continuous head ache ,moderate in intensity,diffuse aching type of pain. Denied having any motor or sensory symptoms. Denied having any trauma to head ,but a vuage history of slipped and about to fall but not remembering to hit his head or not known diabetic ,hypertensive and hypothyroid on regular med.Not on any antiplatelets. On exam vitals stable. Came by walking . BP 140/ 80 mmhg . Optic fundi were normal . No focal deficits. No neck stiffness. What abnormality in the CT brain?

Simultaneous occurrence of head ache and neck pain in a 33yr old female with out any definite focal signs. *Chief Complaints* 33 yr old female,mother of two children, youngest 2 yrs old,presented with simultaneous head ache with neck pain of 2 months duration.Neck pain intermittent ,no radiation, aching type of pain along with head ache.Head ache is diffuse ,throbbing type ,not associated with nausia/ vomiting/ vertigo. No photophobia or phonophobia.Head ache only on getting up from lying position and severe head ache and she has difficulty to look after her children and preferred to be in the bed.For the last two weeks she has some problem in looking straight, but on sidewards ,her vision is prefect. Also has general tirdness.No motor or sensory symptoms .No gait problem also. *History* Detected to be a diabetic 3 months ago but not taking any med .No family history of head ache. *Vitals* Vitals stable. Bp130/ 80 mmhg .Afebrile. *Physical Examination* Normal higher functions and speech. Optic fundi ,- normal ,mild restriction of temporal fields ,ophthalmologist exam reported as normal. Intact cranial nerves.Motor system gr5/ 5 power DTrs equal .plantars flexor bilaterally with intact sensation. Gait- normal. No neck stiffness. *Investigations* Routein lab tests - normal. FBS180 mg/ dl with HbA1c 8,9 %.All other bloid biochrmisyry- normal. MRI with contrast done . For discussion. *Management* What abnormality in the MRI,After joining Curofy,I think this is the 1st MRI of this diagnosis. How will you proceed further? How will you manage this case? Anybody can answer ,but specific case for Neurologist/ Neurosurgeons/ Radiologists

New case 44 yr ,F ,No known comorbidities,not taking any medicine ,Presented with left sided head ache since 1 week more while coughing. Dull aching type of head ache not associated with nausia/ vomiting/ vertigo.She is able to tolerate the head ache and able to do all house hold work.No definite history of trauma,but she is in doubt that her head hit on the window about 2 weeks ago. Examination failed to obtain any focal deficits. Optic fundi normal.On flexing the head she stated that she has headache on the left hemicranium,but no neck stiffness. Diagnosis & management ?