Concluded Case

HYPERTENSIVE EMERGENCY PRESENTED WITH LEFT SIDED WEAKNESS

65yrs/F presented with irritability and confusion for 3 hrs and left sided weakness,before admission to casualty her Bp -220/100,HT -124,Spo2 -98% on room air,RR -32,Pupils - B/l 4mm RTL,GCS - E2V2M4.poor prognosis explained to relatives.

(Edited)

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Concluded answer

Blood in the rt sylvian fissure,3rd ventricle ,4th ventricle.Acure parenchymal bleed rt temporal, rt posterior frontal with involvenent of putamino-cspsulo-thalamic area and midline shift to left,3rd ventricle is compressed and shifterd to left,brain edema rt side with compression of rt lateral ventricle.Brainstem is rorated and compressed. Mild fialatation if left lateral ventricle. Already explind the poor prognosis,but needs Neurosurgery ref for documentation.

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Blood in the rt sylvian fissure,3rd ventricle ,4th ventricle.Acure parenchymal bleed rt temporal, rt posterior frontal with involvenent of putamino-cspsulo-thalamic area and midline shift to left,3rd ventricle is compressed and shifterd to left,brain edema rt side with compression of rt lateral ventricle.Brainstem is rorated and compressed. Mild fialatation if left lateral ventricle. Already explind the poor prognosis,but needs Neurosurgery ref for documentation.

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Intracerebral hemorrhage rt tempoparietal area leakage in rt ventricle with midline shift GCS is poor has poor prognosis Hypertensive needs gradual lowering of bp Inj ns Inj dexamethasone Inj Ceftriaxozone Inj lasix Metaprolol Opinion of neurosurgeon

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Hypertensive hemorrhage Rt external capsule with mass effect and midline shift towards left In view of superficial location this can be evacuated easily Although rt now gcs is low, but post surgery outcome may be better

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1.fairly large acute intracerebral haematoma involving rt capsulo_ ganglio_ thalamic region ,frontal and temporal lobes with significant mass effect , supra and infra tentorial ventricular extension. 2. Small vessel ischaemic white matter changes(leukoaraiosis)3. chronic lacunar infarct in lt thalamus

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Rt acute ganglio capsular thalamic bleed with ventricular breakthrough and subarachnoid hemorrhage

Intraventricular extension of hemorrhage...considering large size.. patient might need decompression procedure... Anything above 80ml is critical...

Acute hemorrhagic stroke with contralateral midline shift . Adv gradual reduction in BP Oxygen support. Neurosurgeon's reference.

Rt MCA TERRITORY I.C.H. TREAT THE B.P AND GAURDED CONSERVATIVE MANAGEMENT .MAY NEED DURGICAL INTERVENTION IF GCS DETERIORATES OR SECOND SCAN SHOWING INCREASE IN THE BLEED SIZE OR MASS EFFECT

Infarct

Good morning Dr,ref to Neuro surgeon+medical(Throbolytic, antiplatelet therapy)

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