A 36 yr old male suffering from rt sided hemiplegia 2 days ago, accelerated htn, family h/o htn , treated with inj. labetolol, and discharged at request due to economic reasons, now on tab. labetolol, eptoin, adv follow up, , ct scan and reports attached



This is a case of Accelerated hypertension Left gangliocapsular bleed(resolving) with right sided hemiplegia. Management includes 1. Manage hypertension. Maintain BP around 150/80. 2. continue Tab phenytoin. Add TAB. folic acid along with it. 3. Management of hemiplegia with good nursing care. position change to prevent bedsores. bowel bladder care. physiotherapy. 4. DO all routine investigations FBS PPBS LIPIDS ELECTROLYTES ECG USG ABDOMEN. all these tests can be done in government hospitals as patient is poor. 5. Add methycobalamine along with folic acid for hyperhomocystenemia. 6. look for cause of hypertension. 7. LSM and dietary restrictions of salt OIL and sweets.

Well explained dear Zuber

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Agree with Dr. Zubair for most part of the suggestions made. There is no need to add seizure prophylaxis to this patient as the bleed in Intra capsular. Evidence shows and guidlines suggest, treatment of homocysteine deficiency has not shown to benefit from preventing further strokes.

Thanks Parvez sir for your valuable comment

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case of hypertensive left basal ganglia bleed without mass effect inspite of tab labetalol other better drug we should like-ARBs or ACE inhibitor calcium channel Hydrochlorothiazide No need to use mannitol and prophylaxis antiepileptics drug. physiotherapy and rehabilitation needed.

good discussion already done. what I want to emphasise is the cause of accelerated ht as he s younge, try to catch any secondary cause with may b curable. just to complete evaluation, what was the fundus examination showing? n any history of elicit drug or alcohol abuse?

most common site of IC bleed due to hypertension is putamen/ capsuloganglionic region.... here it is obvious... reduce the blood pressure slowly over several days... evaluate hypertension...I agree with rest of the treatment

pt having HT and ich in follow up ct shows ich is resolving but edema is there continue tab labetalol tab eptoin add liquid glycerol 15 ml tds with juice multivitamin control ht. watch for sodium

Ieft gangliocapsular haemorrhage with cerebral oedema. Control hypertension & reduce cerebral oedema.

control blood pressure with labetelol . Physiotherapy regular follow up. That's enough

Agree with Dr.Mohammed sir

I agree with Dr Parvez sir and with Dr Gajanan Patil sir. This is a case of young hypertension, so Renal doppler study is very useful test in this context besides other test mentioned.

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