62 male no comorb previous,came w h/o rt side ul weakness n ll weakness,deviation towards rt, slurred speech... o/e bp 200/100,p 80,rr 18.cns-concious,alert (power rt u.l 0/5,rt l.l 2/5.left 5/5 ul n ll),rs clear, cvs s1s2.patient developed fever spike of 99f, cbc-hb 14,wbc 22000,plt 300.rft,lft-nad.ct brain was done attached. rx n further plan of mx plz? thank u..

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It's a lt.basal ganglia capsular bleed hypertensive with mass effect on lateral ventricle and mid brain .... Treatment should be given intravenous labetalol bolus with infusion with oral antihypertensive drug We have to keep Blood pressure below 140/80 consistently, that is very important due to decreasing Blood pressure helps or avoid increasing size of hematoma Give antibiotics if he had fever ?vomiting related aspiration pneumonia. Osmotic diuretic should avoid if Patient conscious obeying alert ..Osmotic diuretic make him electrolyte imbalance and dehydration i/v/I fever and ?aspiration pneumonia. Mostly Rt.fasciobrachial weakness with Rt.lower limb power grade - 2. Physiotherapy and rehabilitation important.

Hw long since d stroke nw.?consider conservative mx for nw..n repeat scan after 48 hrs or watch for neurological deterioration. .whichevr earlier sos consider decompression. .but its highly controversial. Start dexa mannitol meanwhile

Capsuloganglionic bleed left side with compression of left lateral ventricle,mild midline shift to rt side. Suggest control of BP,Compression stockings to lower limbs physio,treat if any infection. Rept CT 24 hrs or earlier if deterioration

Lt sided basal capsular bleed with little or no oedema without midline shift,rt sided hemiparesis is but natural in such type of CVA. Pt is conscious ,BP to be brought down smoothly to the level of 160/90 and not below in 24 hrs or more. Broad spectrum antibiotics to be given to control infection as indicated by fever and high leukocytes count. Antioedema drug may not be required or for very short period. Physiotherapy to be started within 24hrs.No need of any dramatized treatment as any such intervention such as evacuation may have worst prognosis.

Hypertensive left gangliocapsular bleed surrounded by odema. It's acute bleed. Requires osmotic diuretic mannitol . Bp management but shouldn't lower down very aggressively unless there are cardiac complications. Physiotherapist speech and swallowing therapy. Search for focus of infection. And treat accordingly . Bedsore and uti , aspiration pneumonia are common complication of bedridden patient.if patient becomes unconscious then repeat ct and immediate surgical intervention decompression required

CVA,cerebral hemorrhage involving left MCA territory with rt hemiparesis left facial palsy. See fr comorbidities like HTN,DM2,dyslipidemia.Rx -ABCSupport,Statins,as wbc high antibiotics.

Dr parshuram agarwal With a wbc of 22000,pt must have severe infection and bp of 200/100 Must be causing hypertensive encephalopathy locate source of infection like chest x.ray examination of CSF. May need to do urine and blood culture, treat accordingly.

LEFT CAPSULAR HEMORRHAGE.

Capsular hypertensive haemorrhage

Control the bp keep it aroun 150/90.conservative mx.antiepileptic to prevent convulsion.antibiotice..

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