A middle aged woman 45 yrs age presented with complaints of Sudden onset Altered Sensorium, Inability to move left hlf of body and constant looking towards right side since 1 day...There was no h/o any comorbidity or drug intake.....Comment on the approach to this pt...

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As reported in CT scan head acute haemorrhage at right thalamus, detergent peduncle with intraventricular extension in lateral and 3rd ventricle with midline shift , cerebral oedema, obstructive hydrocephalus and left hemiparesis. A MRI scan is required to find out the cause of hydrocephalus. Most likely a hypertensive haemorrhage. Get an ABG done , depending upon the report, a ventilatory support is required. Control of hypertension and stop aspirin and clopidogrel if at all taking . Decongestive therapy with Inj mannitol 100 ml × 8 hourly till patient responds and then glycerol through R.T can be substituted. Inj Eptoin , pantoprazole, supportive treatment. A neurosurgical consultation regarding craniotomy or VP SHUNT for hydrocephalus is required
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Ct showed rt thalamic bleed extending to the body of lt thalamus,compression of 3rd ventricle,blood in the both lateral ventricles rt more than left with extension of bleed in the brain stem.There is associated obstructive hydrocephalus with brain oedema both sides rt more than LT.No mention about hypertension or current BP. Suggest Neuro ICU observation,urgentNeurosugical consultation for hydrocephalus,cerebral oedema measures.Bleed is deep seated.Needs ventilatory support.Sugvest Mri brain with MRA
Left side hemiparesis due to hemorrhagic CVA ....with Cerebral Edema... Rx Ryle's tube feeding Catheterisation Inf Mannitol 200 IV stat and 100ml TDs Inj Ceftriaxone 1 g IV bd Inj levipil 500 IV bd Inj Ondem 4 mg IV TDs Inj Pan 40 IV bdac Inj Citicholine 500 IV bd Inj Hicobal 1 amp charged with NS od Ivf NS 12 hourly To consult Neurologist for further investigation and management EVD may be require...
Hemorragic stroke ...c cerebral edema,obstructive hydrocephalus. Ryel' tube feeding .. Mannitol 100 tds , inj epsolin , inj ceftriaxone 1g bd , pan iv Adv from neurosurgeon regarding shunt & cranitomy
In view of obstructive hydrocephalus due to thalamus and intraventricular bleed Pt needs EVD more so as edema will increase from 2nd day
Thnkyou folks..... Yes this is a case of ICH being managed conservatively but still in a sick condition
Any comment on cxr?. @ dr G. harbillass/dr. S. S patro...
Haemorrhagic stroke with left hemiplegia.
Intracerebral hge with L hemiparesis
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