70yrs old male presented to ER on ventilator support via EMS with H/o Sudden LOC following vomitting.K/c/o - HTN with T2DM since 10yrs on regular medicine.H/o - Fever three days back,TURP was done three years back for BPH.No PMx - CAD,Trauma.O/e - Unconscious on ventilator support,Pupils - B/l 6mm NRTL,GCS - E1VTM2 Labs - Dengue NS1 positive, Platelet counts - 58k.

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He is 70 yrs old with multiple comorbidities Her has Dengue fever, which has caused thrombocytopenia, that has resulted in spontaneous right frontoparietal large subdural hematoma with midline shift and uncal herniation. He has very poor prognosis Neurosurgery may or may not help him, as his general condition is very poor and he has multiple comorbidities with Dengue fever Poor prognosis need to be explained and adequate counseling need to be done.

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Rt. Subdural hematoma pushing the midline significantly, for the time being we need to take a parallel step approach 1. Treat the patient symptomaticaly for dengue fever 2. Involve neurosurgeon for evacuation 3. Manage BP 4. Poor prognosis as of now

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Acute SDH rt frontotemporoparietal area with hypodensity with in the SDH with significant midline shift to left,compression of RT lateral ventriclr with dilatation of posterior horn of left lateral ventricle.Uncal herniation to left.platelet count 58k and this amount will not produce bleed. Suggest opinion of neurosurgeon.prognosis seems to be poor

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Acute SubDural hemorrhage..neurologist opinion... surgical evacuation...

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Acute subdural heamatoma with mass effect with mid line shift

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There is rt subdural acute bleed, with significant midline shift. Evacuation with guarded prognosis can be done.

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Rt subdural hematoma with mass effect.needs to be evacuated and platelets to be maintained 80000-100000..supportive care, watch for ards(to change ventilator settings), maintaining Hb, bp and hematocrit monitoring.

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Repeat CT head

Has clot evacuation been done?there is still mass effect but this scan appears better than the previous scan and also the platelet count is good.is there clinical improvement?
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Sdh with significant midline shift.. need neurosurgrical opinion.. Two questions: what is the role of giving sdpc in this patient(with hemorrhage)?

Single donor platelets have less chances of spread of blood borne infections, cause more rise in platelets and cause less alloimmunization..particularly in this patient, it is less likely that thrombocytopenia has caused the bleed as platelets are 58000 which is an adequatenumber..as neurosurgery is needed, the platelets have to be kept to levels of 80000-100000.as far as platelets are kept to this level, I do not feel there is any special advantage of sdp in this patient.even in other patients, sdp is helpful in patients needing large amount of platelet transfusion without expected rise.sdp is difficult to get( in many places), it is better to give whatever available platelets in lifesaving situation than to wait for sdp.
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Repeat Platelet counts

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