58yrs old male brought in ED in drowsy condition having H/o sudden fainting after the pain and dizziness in the head due to raised in Bp with complaints of left sided hemiplegia and restlessness.Upon arrival in emergency patient GCS - E2V2M5,Pupils - B/l Small size reactive,Bp - 180/90mmhg,pr - 78/mt,Spo2-96%,BSR-209mg/dl K/c/o ?HTN,N/h/o any other comorbidy. Diagnosis and suggest management plan??




CVA Hypertensive Bleed (Right Capsuloganglionic Region) ....Try to decrease ICP using all measures and electrodes to monitor the same....keep BP around 140-150 systolic abd use Labetalol for the same...Do MR /CT angio to ruke out any aneurysmal bleed

There is a large right capsuloganglionic hypertensive hematoma with mild intraventricular extension Mass effect and mid line shift with some uncal herniation Intubation and mechanical ventilation followed by decompressive craniotomy will give a good chance of saving the Patient Will require aggressive Physiotherapy and general supportive care

Acute ICH with midline shift and mass effect. Maintain ABCDE and Vitals. Sedation, Intubation & Ventilation. Good Oxygenation and mild low paco2. Antiepileptic, Antiodema, Antiemetics.... Urgent Neurosurgeon & Neurologist Urgentaly Need further evaluation& Rx.

Looks Haemorrhage in Froto parietal region. So aphasia because of probably involving Brocka area having low v score with midline shift involving right side. Mannitol high doses with at least 15 ml piracetam tds, mange RBS and BP with nifedepine sublingual. Mange vitals

Rt caudate region hypertensive haemorrhage Manage conservatively if theres no cushings triad Otherwise go for clot decompression

Intracerebral hemorrhage with mass effect...could be aneurysmal bleed ....apart from antiedema measures and anti epileptics he should be started on nemodipine ... intubation and mechanical ventilation..

Right capsuloganglionic bleed with intraventricular extension with mass effect.treatment for raised ICT with decongestive therapy and control of blood pressure.if GCS drops further go for neurosurgical intervention

Right BG HT bleed with IVH and cerebral edema Midline shift to left

Right capsuloganglionic bleed with midline shift Require immediate decompressive craniotomy Inj mannitol 100 mg IV tid Inj labetalol infusion

Add anti epileptics


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