Concluded Case

56yrs/F presented to ED with Complaints of Holocranial headache of 2 months duration, drowsiness, excessive sleep.Past H/o B/l TKR(2015), Hysterectomy 10yrs before,Known/c/o OSA,T2DM,RA× 10yrs..Patient had focal seizure and respiratory distress,so intubated in triage Chief Complaints Headache, drowsiness, excessive sleep History H/o B/l TKR(2015), Hysterectomy 10yrs before. Vitals Bp -110/70,Pulse -82,RR -22,Spo2 -88% Physical Examination GCS - E1M4V1 on presentation,Pupils - B/l 2mm RTL,Power - 5/5 right upper and right lower limb,2/5 left upper and 3/5 left lower limb,Plantar B/l upgoing,Chest - B/l clear Diagnosis Diagnosis? Management Suggest management plan?

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Concluded answer

I'll defind mixed density lesion in the Rt caudatoputaminal area involving the posterior frontal and temporal white matter with severe brain oedema, midline shift ,compression of rt lateral ventricle with early uncal herniation. Posteior horn of both lateral ventricle started dialating, This is an emergency case, why contrast is not given ? Suggest MRI brain with contrast and MR spectroscopy. High gr glioma vs lymphoma.

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I'll defind mixed density lesion in the Rt caudatoputaminal area involving the posterior frontal and temporal white matter with severe brain oedema, midline shift ,compression of rt lateral ventricle with early uncal herniation. Posteior horn of both lateral ventricle started dialating, This is an emergency case, why contrast is not given ? Suggest MRI brain with contrast and MR spectroscopy. High gr glioma vs lymphoma.

Illdefined sol involving rt basal ganglia,adjacent part of temporal and frontal lobes with perilesional oedema and significant mass effect including obstructive acute supratentorial hydrocephalus . Likely glioma. Biopsy tract with intralesionsal air pocket seen . Check biopsy report. Neurological and oncological work up

Valuable opinion
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Rt parietal area and substantial nigra suggest hypodense area of collection likely hemorrhage as leaking in rt ventricle and midline is shifted Vitals are stable except pt is hypoxic Intubation and maintain ventilation Opinion of neurologist Prognosis is poor

SOL
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Hydrocephalus Ischemic stroke inrt parietal region Mental state good Opinion of neurologist Midline shift to left Lt lower hemiparesis

DD sol
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Appears to be icsol? Gbmwith midline shift. Take mri plain contrast&spectroscpy. Immediate icu treatment anti icp measures.r.once improved sugery is the choice.

Valuable opinion
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Wow! This is rather impressive. SOL likely GBM. I would intubate her and ask for NSGY consult stat. Get an MRI. Poor prognosis as these tumors even when not in that bad a state have an average survival of 12 months.

Tumor. ? Astrocytoma with. Mass effect with mid line shift

lesion is mixed density grossly round in nature in right frontotemporal region causing mass Effect of ipsilateral ventricle and midline shift with grade 1 -2 perilesional edema. There is hypodensity in middle of lesion? Air. There is subfalcine herniation and uncal herniation on right side. Due to block of third ventricular region causing hydrocephalous. Patient needs anticonvulsants. Antiedema measure initially. Needs MRI BRAIN PLAIN AND CONTRAST WITH MR ANGIOGRAPHY. DD TUMOUR - GLIOMA , MENINGIOMA ICA /MCA ANEURYSM. After imaging plan accordingly.

Looks like an SOL with midline shift and hydrocephalus, steroids and and other drugs to reduce edema. Needs neurosurgeon's opinion for decompression/vp shunt. For evaluation pt needs an mri with contrast f/b biopsy if necessary for confirmation of diagnosis.

Valuable opinion
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Craniotomy &excise the icsol. Followed by radio&chemo

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