Concluded Case

Major Hyperyensive ICH

42 yr ,M ,presented with abrupt onset of loss of conciousness and fell down on 5th October at 3 PM while getting out of his office. No head ache / vomiting / seizures.He was taken to nearby hospital intubated and mechanically ventilated and then transferred.Ct brain was done before transferring. Known hypertensive ,detected 2 yrs ago, not taking medicine since 3 months. On exam: BP 200/ 130 documented at another hospital ,current BP 150/ 100mmhg. On ventilator pupils Both 6 mm,non- reactive. Dolls eye movements absent. DTRS uniformlycabsent( sedated and medically paralyzed). Patient is admitted in the Neurosurgery ICU. What abnormality in the CT. What is the clinical status of the patient? What is the prognosis?

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Concluded answer

Thanks Curofy and others. CT brain shows* intraparenchymal hematoma involving left thalamus ,lentiform nucleus, internal capsule,external capsule,, corona radiata,centrum semiovale,left crus of midbrain,left oaramedian midbrain,and superior aspect of left hemipons. * Intraventricular extention of bleed in to bilateral lateral, 33rd and 4th ventricles. * SAH in the perimesencephalic cisterns premedullary cisterns, anterior interhemispheric fissure,paramedian frontal sulcal spaces,bilateral sylvian fissures. * Mass effect with midlineshift to rt side. * Mild teanstentorial,subfalcian and uncal herniation . * Diffus3 cerebral edema. patient is under Neurosurgeon. On conservative treatment. Tracheostomy done. Stable at present.

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Thanks Curofy and others. CT brain shows* intraparenchymal hematoma involving left thalamus ,lentiform nucleus, internal capsule,external capsule,, corona radiata,centrum semiovale,left crus of midbrain,left oaramedian midbrain,and superior aspect of left hemipons. * Intraventricular extention of bleed in to bilateral lateral, 33rd and 4th ventricles. * SAH in the perimesencephalic cisterns premedullary cisterns, anterior interhemispheric fissure,paramedian frontal sulcal spaces,bilateral sylvian fissures. * Mass effect with midlineshift to rt side. * Mild teanstentorial,subfalcian and uncal herniation . * Diffus3 cerebral edema. patient is under Neurosurgeon. On conservative treatment. Tracheostomy done. Stable at present.

Left gangliocapsular hemorrhage extended up to brainstem with IVH with significant midline shift and obstructive hydrocephalus Need to know GCS without sedation and paralytic agent. Opinion from neurosurgery for EVD and if there is any sign of improvement pt may taken for definitive surgery (hematoma evacuation ) Any how prognosis remain poor.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Large left cerebral bleed with ventricular breakthrough with mid line shift with subaravhnoid hemorrhage

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