Concluded Case

LARGE BG BLEED WITH INTRAVENTRICULAR EXTENSION WITH GRAVE PROGNOSIS

75yrs/F known Hypertensive presented to casualty after Sudden spontaneous collapse following severe headache.Parient on Ventilator support. O/e - GCS - E1V1M2,Pupils - B/l Full Dilated fixed non reactive,BP - 200/100.INTERPRET CT HEAD FINDINGS?

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Concluded answer

An extensive hypertensive intracranial bleed most likely due to rupture of a berry aneurysm involving 1.left tempro- parietal region 2.Extending into the ventricles 3.Brain stem region , thalamus , caudate nucleus . A poor prognosis due to 1.Severe raised intracranial pressure 2.Global cerebral ischaemia considering the extent of bleeding and remaining part ot the brain not receiving enough blood flow and oxygen to sustain cellular metabolism 3.Involvement of vital centres in brain stem region 4.Obstructive hydrocephalus Treatment- 1 Ventilatory support 2.Decongestive therapy 3.Gradual lowering of B.P with labetalol in drip 4.AED"s 5.Supportive care , IV fluids , catheterization and parenteral antibiotics

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An extensive hypertensive intracranial bleed most likely due to rupture of a berry aneurysm involving 1.left tempro- parietal region 2.Extending into the ventricles 3.Brain stem region , thalamus , caudate nucleus . A poor prognosis due to 1.Severe raised intracranial pressure 2.Global cerebral ischaemia considering the extent of bleeding and remaining part ot the brain not receiving enough blood flow and oxygen to sustain cellular metabolism 3.Involvement of vital centres in brain stem region 4.Obstructive hydrocephalus Treatment- 1 Ventilatory support 2.Decongestive therapy 3.Gradual lowering of B.P with labetalol in drip 4.AED"s 5.Supportive care , IV fluids , catheterization and parenteral antibiotics

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Left thalamocapsuloganglionic bleed with blood in the lateral,3rd and 4th ventricles with compression of left lateral ventricle,midline shift to rt with tentorial herniation and downward displacement of brainstem with hydrocephalus. Major hypertensive ICH. Poor prognosis. Ref to Neurosurgeon for documentation. Supportive management. Informed the relatives regarding poor prognosis.

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Left thalamocapsuliganglionic bleed with blood in lateral 3red and 4th ventricle with hydrocephalus,compression of left lateral ventricle,midline shift to rt side,tentorial herniation to rt with brain edema. Major hypertensive bleed ,poor prognosis, neurosurgery opinion for documentation,conservative management. Informed the relatives about the prognosis

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Left basal ganglia bleed with ivh. Can go for endoscopic evacuation of hematoma with EVD placement. Prognosis not good.

Acute haemorrhage in lt brain stem thalamic lt ventricle left Cerebral oedema Opinion of neurosurgeon Explore

Acute cerebral bleed with ventricular breakthrough

surgery can't help much in this case

left capsuloganglionic bleed extending upto lateral horn of fourth ventricle