Major Hyperyensive ICH

30 yr old male brought to ED with multiple episodes of seizures since last one week, on the day of arrival since morning patient had four episodes of seizures in between regained consciousness, h/o headache present, no history of vomitings and fever, past history of growth retardation since childhood, and weakness of left upper limb since childhood, history of similar seizure episode one year back subsided with local treatment, on arrival to ED, vitals BP 13/90 mm of hg, PR 69/min, RR 19 /min, a febrile, GRBS 129 mg/dl, CNS pat is conscious and oriented obeying commands, left upper limb power 4/5,pupils b/l equal sluggish reacting, other systemic exam normal, CT brain uploaded, discuss abt diagnosis and management

65 yrs male brought to ER with unresponsiveness state. GCS e1v1m3. pupils bl/ns/sr. interpret the image and management?

A middle aged woman 45 yrs age presented with complaints of Sudden onset Altered Sensorium, Inability to move left hlf of body and constant looking towards right side since 1 day...There was no h/o any comorbidity or drug intake.....Comment on the approach to this pt...

A 68 yr old female who was a k/c/o Syst HTN presented with sudden onset fall in washroom in the morning and Altered Sensorium and was brought to ED...At presentation, her pupils were mid dilated and sluggishly reacting and b/l plantar response was Extensor....Discuss the treatment approach to this pt

WHEN DO YOU NEED A HEAD CT BEFORE AN LP? The LP is useful for diagnosing meningitis, subarachnoid hemorrhage, and other auto-immune or inflammatory disorders. However, the LP will obviously not be appropriate for diagnosing a brain mass, a stroke, or a skull fracture. In general, when you are suspecting any of these based on the history and physical, the patient should have appropriate imaging first. Here is a quick mnemonic for patients in whom you should consider a CT before an LP, with the acronym “TAP AS IF”. Trauma Age > 60 Papilledema (or other sign of increased ICP) Altered mental status Seizure Immunocompromised (HIV/AIDS) Focal neurologic deficits such as hemiparesis or new anisocoria, which can be a sign of impending herniation, typically accompanied by severe altered mental status. If the patient has an obvious source of their symptoms on CT, such as a mass, hematoma, fracture, or abscess, then the LP can be deferred if the findings explain the clinical history. If they have signs of midline shift, obstructive hydrocephalus, or cerebral edema, then an LP should be avoided.