Concluded Case

Sudden onset loss of consciousness

A 70 years old male with history of sudden loss of consciousness - a known hypertensive on regular treatment On Examination- E3 M3 V5 . Bilateral pupils reacting to light - left side sluggish Chest and CVS - NAD INTERPRET NCCT Scan of head AND OPINIONS WELCOMED

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I agree with the opinions of Dr Manorama Rajan and Dr Shivraj Aggarwal. I just will add that there is a large area of encephalomalacia with Hemosiderin rim in right basal ganglia region and right corona Radiata, There are also small infarcts in right frontal and parietal lobes A small focus of microhaemorrhage in right occipital lobe

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Rt parietal lobe shows hypodense area in periventricular area extending to rt post cerebellar sulci and inf ventricle in perimedula oblangata It is a c/o intra cerebral hemorrhage leakage in post cerebellar area Pt is kco of hypertension and regular on treatment but don't know wether was under control or not as sudden surge in bp in atherosclerotic age group this is known macrovascular complication in long standing cases So far rx is concerned inj manitol Inj lasix Monitor bp in gradual steps Use of anticoagulants like inj enoxiparum or clexan depends on extent of bleed Inj dexamethasone 8hrly Inj Ceftriaxozone bd Rest supportive treatment Also assess cardiovascular status by ecg and 2decho

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NCCT shows Rt MCA branch infarction. Not an acute or hyperacute one. Needs MRI brain to exclude posterior circulation dysfunction in view of the sudden loss of conciousness.

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I agree with the opinions of Dr Manorama Rajan and Dr Shivraj Aggarwal. I just will add that there is a large area of encephalomalacia with Hemosiderin rim in right basal ganglia region and right corona Radiata, There are also small infarcts in right frontal and parietal lobes A small focus of microhaemorrhage in right occipital lobe

Hypodense lesion in rt cistern in grey matter Ischemic stroke Opinion of neurologist Intubate Follow up mri 2 hrly change position Air bed

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Rt mca territory acute infarct Evaluate for etiology Atherosclerosis vs cardiac Evaluation cardiac function, vascular study Start anti platelet with statin Bp control, in view of significant atrophy pt can be managed conservatively

? ICH .. ? INTRA CRANIAL PATHOLOGY.. NEED'S.. MRI STUDY.. NEUROSURGEN'S OPINION..

right MCA infarct neuology opinion

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Stroke

I agree with Dr Shivraj Agarwal.

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