49yrs male presented to the ED with acute onset of dysarthria and right sided hemiparesis with slurred speech and facial asymmetry.His GCS on hospital arrival was 14/15 with blood pressure reading of 170/90 mmHg.Family members reported that the complaints was started at about one and a half hours before admission.N/h/o Headache,vomitting and seizure,No past medical H/o HTN,CAD,DM O/e Conscious but disoriented,Afebrile Pupils - B/l 4mm RTL GCS - 14/15 power Right UL - 0/5,LL - 3/5 Lt UL - 5/5,LL-5/5 BP - 170/80mmhg,PR - 88,Spo2 - 100% DIAGNOSIS AND MANAGEMENT PLAN??

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A left hypertensive thalamic haemorrhage with facial palsy with involvement of trigeminal, facial and hypoglossal nerve causing dysarthria , slurred speech and facial asymmetry. Right sided hemiparesis due to crossed pyramidal tract fibres . Management is conservative with Control of B.P with lasix , decongestive therapy with mannitol , AED,s Once B.P is controlled and antihypertensives are started , prednisolone can be started and tapered in 2 - 3 weeks for perilesional oedema and facial asymmetry a d dysarthria

Steroid contraindicated in hypertensive ICH,
1

LT thalamic bleed wtb extension to lt upper midbrain with compression of posterior part of 3rd ventricle . At this stage there Is no hydrocephalus. In addition this Mri shows some other finding FLAIR hyperintensities bilateral periventricular with microbleed.Neesds further investigations for vasculitis including pAN

Adjacent part of midbrain (crus) also involved causing the dense hemiplegia contralaterally. My question is whether there is an SOL like AV malformation or Glioma associated. @Dr. Indira Devi

Thalamic hemorrhages, watch for hydrocephalus in these patient , as foramen of Monroe is close by.othereise controll HTN, they improve

Left thalamic bleed , without mass effect at present.. Bp control , conservative management Look ECG , echo for evidence of HTN

Lt. Thalamic heammorage need stat neurosurgeon intervention, management of HT required.

Left thalamic bleed. Management of hypertension and cerebral decongestants

Left thalamus hypertensive bleed with no extension into the ventricles

Left thalamic bleed

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