a56 yr old Male patient Known case of diabetes and htn on treatment, today morning presented with fall in bathroom and recovered After that pt went outside and fell down, unconscious. pt brought with unconscious with froth in mouth PR 74per min BP 170/90, plantar bil extensar, snoring present.E1VIM1. History of head injury 30yrsback ,1yr back fell down from bike investigated outside and started on levipill500mg bd , phenytoin 100mg bd, and oxcarbapazine. ct and blood report's attached.ecg normal. what is the diagnosis, and treatment.

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Pontine bleed

Thank-you all

NCCT shows bleeding in mid brain Probably bleeding due to fall down or hypertension Poor prognosis to be explained Report show uncontrolled diabetes and high range of pus cells and albuminuria Antibiotic like azitreonam iv TDS Injection levipil 500 mg bd Injection phenytoin 100 mg tds Injection pan 40 iv bd inj menitol 100 mg iv bd Injection cognistar iv For sugar insulin according to sliding scale

Midbrain or pontine haemorrhage likely hypertensive. Conservative and supportive treatment only. Guarded prognosis

Agreed ncct shows pontine or mid brain hemorrhage hypodense area is also seen in rt parietal area probably old infarct as pt is kco of ht dm and on anticonvulsants as well his reports shows uncontrolled bsl as random is more than 321mg and urine shows 3+albuminurea and plenty of pus cells suggesting urinary infection hence further workout and control the sugar with insulin and infection with macrobiotic like meropanum with defined mx of CVA

Thanx dr Arun Patel
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Ponto medullary hemorrhage poor prognosis

Bilateral periventriculsr hypidensity suggestive of CSVD.Inaddition hyperdense lesion I the pons suggestive of bleed.No hydrocephalus at present

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!

NCCT shows Midbrain bleed leading to Above mentioned Symptoms....i.e. Respiratory Distress, Unconsciousness... Probably Hypertensive bleed... Poor prognosis to be explained Conservativemanagement

Thank-you
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