LOC in a patient with hemiparesis
74 years old male - a known case of hypertension and hemiparesis since last 3 years . Hypertension is controlled . He suddenly developed increasing drowsiness since last 3 years E2 V4M 5 MRI Scan was done Comments on MRI scan and its interpretation is welcomed
T2 hyperintense well demarcated lesion in the left gangliocapsular area with dialatation of ipsilateral lateral ventricle suggestive of old stroke.Inaddition perilesional and periventricular hyperdensity with ill defind hypodensity rt caudate nucleus & Corona radiate suggestive of CSVD. FLAIR multiple hyperintensity noted including temporal gray matter rt side suggestive of multiple infarctions/ CSVD
T2 hyperintense well demarcated lesion in the left gangliocapsular area with dialatation of ipsilateral lateral ventricle suggestive of old stroke.Inaddition perilesional and periventricular hyperdensity with ill defind hypodensity rt caudate nucleus & Corona radiate suggestive of CSVD. FLAIR multiple hyperintensity noted including temporal gray matter rt side suggestive of multiple infarctions/ CSVD
RT side periventricular lesion in rt parietal lobe in cuadate region is fresh cerebral stroke Intracerebral hemorrhage leakage in rt ventricle Lt side lesions are probably old infarcts So pt is probably now in lt side hemiparasis or hemiplegia as well Treat as CVA
I agree with Dr Manorama Rajan and Dr Shivraj Agarwal regarding their interpretation of the MRI scan . Characteristic feature of this MRI scan was Large area,of encephalomalacia with HEMOSIDERIN RIM in right basal ganglionic region and right corona radiata Also small acute infarcts in right frontal and Parietal lobes,associated dilatation of left lateral ventricle and small focus of haemorrhage in right occipital lobe
Acute hhg in lt cistern Known pt of hypertension with hemiparesis Opinion of neurologist Intubation
आयुर्वेद के अनुसार रोगी वात व्याधि से ग्रस्त है। चिकित्सा संबंधी योग,,, बृहत वात चिंतामणि रस स्वर्ण युक्त 1 रत्ती एकांग वीर रस 2 रत्ती रस राज रस 1 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं। महारास्नादि क्वाथ 25 ग्राम सुबह-शाम खाने के बाद दें। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।
Hydrocephalus
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46 yr,M , Preented with head ache followed by left sided weakness on 4th of this month after taking his lunch and on the way to washroom.Sudden onset of mild headache only with out any nausia / vomiting. Know hypertensive 6 yrs ,on amlodipine but missed 3 day amlo. Non smoker ,occ ethanol once in a month only last drink august 30th. On exam BP 170/ 100 mmhg ,fulyconcious,communicating well.Left sided hemiplegi with gr3/5 power with hyperreflexia left with extensor plantar. Current state,BP well under control,getting physio,supportive care .Motor Power started improving. What is the diagnosis?
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49yrs male presented to the ED with acute onset of dysarthria and right sided hemiparesis with slurred speech and facial asymmetry.His GCS on hospital arrival was 14/15 with blood pressure reading of 170/90 mmHg.Family members reported that the complaints was started at about one and a half hours before admission.N/h/o Headache,vomitting and seizure,No past medical H/o HTN,CAD,DM O/e Conscious but disoriented,Afebrile Pupils - B/l 4mm RTL GCS - 14/15 power Right UL - 0/5,LL - 3/5 Lt UL - 5/5,LL-5/5 BP - 170/80mmhg,PR - 88,Spo2 - 100% DIAGNOSIS AND MANAGEMENT PLAN??
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