Concluded Case

Left frontal Lobar hematoma

82 yr,M, admitted with sudden onset of head ache,vomited once followed by mild drowsiness on 21 August at 10:30 hrs. Diffuse head ache .No definite motor weakness noted. He is a known hypertensive 20 yrs ,on metformin for 6 months for DM ,on Thyronorm 25 mcg for 11 yrs. He is not on any antiplatelets or anticoagulant. On exam drowsy on shaking and asking he is answering ,but the speech is not clear ,partly due to adentulous state.Bp 130/ 80 mmhg. Pupils normal size,Mild facial asymmetry rt side.Moving all 4 limbs .Good grip bilaterally.DTRs uniformly hypoactive with flexor plantars.Gait not tested. Blood work up nothing significant. CT brain and MRI both done. MR Angio and venography normal Comment on the pictures.

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Concluded answer

Thanks Curofy and all Doctors who answered the case. Most of you have given the correct answeres. Patient became better with symptomatic treatment,discharged ,on home physio. CT brain and MRI done. Acute intraparenchymal hematoma with mild perilesional edema causing mass effect in the form of effacement of adjacent sulci, left sylvian fissure,bilateral frontal horns body of left lateral ventricle noted on the left frontal lobe extending to left capsuloganglionic region.Occipital horn of left lateral ventricle is dialated with dependent mild ventricular extension of hemorrhage. Mild midline shift to Rt 7 mm. Imp Left frontal lobar hematoma

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Thanks Curofy and all Doctors who answered the case. Most of you have given the correct answeres. Patient became better with symptomatic treatment,discharged ,on home physio. CT brain and MRI done. Acute intraparenchymal hematoma with mild perilesional edema causing mass effect in the form of effacement of adjacent sulci, left sylvian fissure,bilateral frontal horns body of left lateral ventricle noted on the left frontal lobe extending to left capsuloganglionic region.Occipital horn of left lateral ventricle is dialated with dependent mild ventricular extension of hemorrhage. Mild midline shift to Rt 7 mm. Imp Left frontal lobar hematoma

Hemorrhage in Left Frontal lobe with intraventricular extension and significant midline shift...Mild right sided facial asymmetry... DTR decreased.... At present, condition is relatively stable but deterioration can occur... BP is normal at present...

Hemorrhagic infarct with midline shift with ischemic changes See hemocystine level See thyroid profile See ecg and 2decho See blood report See hba1c And treat accordingly

CT scan shows hyperdense shadow at frontoparietal region with midline shift to Rt of ventricles lateral and brain parenchyma. Intracerebral haemorrhage lt frontoparietal lobe.

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Hemorrhagic infarct with mild shift. Treat conservatively.keep monitoring the progress of disease.

Mam site seems very unusual for hypertensive hemorrhage More likely secondary hemorrhage

Lobar hemorrhage mam
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Acute cerebral bleed with mass effect with mid line shift

Left frontal ICH with midline shift

Cold compress 20 to 30 minutes in 48 hours and elevating your foot higher than your heart and light compression with a wrapped bandage ana pain medication such as Acetaminophen ( Tylenol).. take rest

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