Concluded Case

ICH + IVH CAUSE HYPERTENSION

67 year old male patient Known HTN on irregular medicine and COPD with a History of sudden onset Right side hemiparesis followed by drowsy disoriented state since four hours presented to the ED. On general examination He was tachycardic with a heart rate of 104 beats/min and a blood pressure of 200/100 mmHg. Neurological assessment was suggestive of power 0/5 in Righ upper and lower limb with Right upper motor neuron facial palsy. No other neurological findings were present. Other systems were unremarkable.O/e - Pupils - B/l 4mm SRTL,GCS - E2V3M4. DIAGNOSIS AND SUGGEST TREATMENT PLAN FOR THIS CASE?

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Concluded answer

Left putaminocapsular bleed with adjacent temporal lobe involvement with leakage of blood to left lateral ventricle with mild perilesional edema. Suggestconservative management at present. Needs opinion from Neurosurgeon. Rept CT24 hrs ,earlier if clinical deterioration. Endoscopic evacuation of hematoma if any signs of deterioration.

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A left basal ganglia region hypertensive haemorrhage with temporal lobe involvement and extension into left lateral ventricle and associated perilesional cerebral oedema - and most Likely a berry aneurysmal rupture. Best option in this case is 1 A ventilatory support will reduce intracranial pressure and take care of respiratory insufficiency due to associated COPD as seen in X - ray chest 2.A Gradual lowering of hypertension with labetalol in drip 3.Start decongestive therapy with mannitol anx add AED'S 4 If after 24 hours decongestive therapy there is deterioration in GCS a neurosurgical advice and surgical intervention may be needed

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Left putaminocapsular bleed with adjacent temporal lobe involvement with leakage of blood to left lateral ventricle with mild perilesional edema. Suggestconservative management at present. Needs opinion from Neurosurgeon. Rept CT24 hrs ,earlier if clinical deterioration. Endoscopic evacuation of hematoma if any signs of deterioration.

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Left capsuloganglionic hemorrhage with seepage into lateral ventricle, without significant mass effect . Xray chest shows ? Old PT with,COPD and cardiomegaly Conservative management , with antihypertensive and anti edema measures.

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Left gangliocapsular bleed. ? Ventricular extension. Adv intubation Mechanical ventilation and keep low TV, hyperventilation, in view of c02 wash. Supportive treatment. Conservative management. Neurosurgeon's reference. Follow up CT.

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Left gangliocapsular bleed with ivh. Further management depends on GCS As pt is also a k/c/o copd, pt required nebulization with optimum o2 either bi BiPAP is gcs is good or ventilatory support for low gcs. Neurosurgeon must be kept on board. Repeat ct after 24 hrs Although as per pts age, sometimes pt ay not required surgical intervention. Improvement by conservative management can be there Cerebral decongestant required.

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Conservative management. Serial CT scans to look for hydrocephalus, if present EVD can be considered.

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I am agree with@Dr. Krishnan Pichumani Sir and, @Dr. Manorama Rajan Ma'am.

Thank you ,Dr Pranab Bera
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Ganglionic bleed conservative only for brain

NICE ILLUSTRATSTION

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