Concluded Case

AVM with bleed - left frontal and subcortical region

24 yr old ,M, developed abrupt onset of head ache ,vomited once and developed rt lower limb weakness 3 days ago.No seizures. No trauma to the head. No previous history of head ache. Denied having any known medical or neurological problem. Non smoker ,not in the habit of taking ethanol. On exam BP 120/ 80 mmhg. Vitals stable. fully concious communicating well. Intact cranial nerves. Motor system gr5/ 5 power in the upper limbs, 3/ 5 rt lower limb ,and 5/5 left lower limb. Biceps ,triceps ,supinator rt side upper limb 3+ rt lower limb 4+ ,left side 2+ . Intact sensations. No neck stiffness. Routein blood work up including biochemistry were normal.Pt ,INR normal Covid -ve. Case is under Neurosurgeon and surgical management is today. Diagnosis?

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Concluded answer

Thanks for all answeres. Diagnosis : CT brain with CTA done. * Hyperacute intraparencymal hematoma involving left frontal lobe,corona radiata,capsuloganglionic region causing mass effect with effacement of ipsilateral cortical sulci,frontal horns of bilateral lateral ventricles. * Mild tentorial herniation. * Intraventricular extension to bilateral lateral ,3red and 4th ventricles. ** Abnormal tuft of vessels with nidus in the left frontal subcortical region antero superior to the hematoma.Multiple tortuous training vein in the lateral aspect of nidus forming as single vein to drain in to the superior sagittal sinus Imp A VM wit rupture left frontal and subcortical area. Suggested surgery ,pt discharged at request to go to Govt Medical College due to financial problem

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Thanks for all answeres. Diagnosis : CT brain with CTA done. * Hyperacute intraparencymal hematoma involving left frontal lobe,corona radiata,capsuloganglionic region causing mass effect with effacement of ipsilateral cortical sulci,frontal horns of bilateral lateral ventricles. * Mild tentorial herniation. * Intraventricular extension to bilateral lateral ,3red and 4th ventricles. ** Abnormal tuft of vessels with nidus in the left frontal subcortical region antero superior to the hematoma.Multiple tortuous training vein in the lateral aspect of nidus forming as single vein to drain in to the superior sagittal sinus Imp A VM wit rupture left frontal and subcortical area. Suggested surgery ,pt discharged at request to go to Govt Medical College due to financial problem

nidus sparing sign not much appreciated..but a superficial avm is surgically excisable...i have no experience to tackle avm...it should be done only by neurosurgeons used to doing avm

Rt side paralyzed due to Lt side motor neuron disorder?? Lt occipital region (black spot) cerebral hemorrhage??

Thank you doctor
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Looks like some aneurysm or AV malformation rupture left frontal parenchymal hematoma with IVH Some feeders are visible in sagital section CTA !!!

Acute cerebral bleed with ventricular breakthrough with mild mid line shift

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