Concluded Case

HIGH GRADE NEOPLASM

44yrs old presented to casualty in unconscious and decerebrate state, intubated and put on mechanical ventilation as per ACLS protocol.Patient brother stated that patient had H/o Headache beginning 6mnths before with vomitting today he had 3 episodes of GTCS then Unconsciousness since then. O/e - O/e - Unconscious,Left sided hemiplegic.Pupils - Right 7mm NRTL,left 4mm SRTL,GCS - E1M2V1,Plantars extensors.BP - 130/90.APPROACH??

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Concluded answer
Rt. Temporal gbm..Good surgery good outcome..Unfortunately patient has presented too late.. give 1 full dose mannitol and take up emergency surgery
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A large space occupying lesion right temporoparietal region with gross and significant midline shift with compression of right lateral ventricles and impending herniation and perilesional cerebral oedema .Most likely a cerebral malignancy tumour- Glioblastoma multiforme which have a poor prognosis. Approach - Continue mechanical ventilation as it will decrease intracranial pressure. Start IV line - inj Dexamethasone 8 mg .B.D Inj Phenytoin × 8 hourly . Supportive treatment, Nothing definitive can be done right now Once there is decrease in ICP and G.C.S Improves - a neurosurgical consultation can be taken, but right now carries a poor prognosis.
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Ct brain single set of contrast available. No plain scan posted.well defind mixed density lesion in the Rt temporal with perilesional edema,mid line shift with uncal herniation to left.Unable to comment on contrast enhance due to lack of pkain film.Rt lateral and 3rd ventricles are compressed and pushed to left side. Ocular findings due to uncal herniation and midbrain compression. Continue antiepileptic,Mannitol to reduce cerebral edema. Continue ventilatory support. Poor prognosis Needs Neurosurgeons documentation.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
Thank you doctor
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Heterognous lesion involving right sided of brain It may be tumor or CVT... Advise - MRA brain and venogram and spectroscopy Treatment- antiepileptics .anti oedema
Rt. Temporal gbm..Good surgery good outcome..Unfortunately patient has presented too late.. give 1 full dose mannitol and take up emergency surgery
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Ct s/o rt temporal mass with edema and midline shift Mass is heterogeneous D/d High grade glioma , abscess
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Glioblastoma
@Dr. Yashesh Dalal sir,@Parveen Yograj sir,@Manorama Rajan mam,@Anand Kumar sir,@Abhijit V sir,@Bhupesh Kumar sir
Glioblastoma Ekangvir rasa Smritisagar rasa Arogyavardhani vati Jatamansyadi kwath Kachnar guggulu Draksharishra
MRI brain done instead of CEMRI N MRS.Relatives ready for surgery with poor prognosis explained.
This is the best option under these circumstances as if not operated patient may not survive and intraoperative risk is also very high as duration of anaesthesia will be quite prolonged and even after successful surgery long term survival is poor as recurrence rate is very high
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