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??




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,

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

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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

Left thalamic bleed

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

Conservative at present. Repeat scans to r/o hydrocephalus in future. Get an Angiography done.

Left thalamic bleed. Management of hypertension and cerebral decongestants

Left thalamic bleed

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

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