Concluded Case

Intraparenchymal hematoma left frontotemporal with SAH

New case 47 yr old ,M, Known hypertensive for 10 yrs on irregular med, presented with acute onset of head ache followed by rt sided weakness with difficulty to communicate. On the way to hospital he developed one episode of generalized fit. Evaluated at local hospital and received fosphenytoin 1gr stat and then and intubated and Mechanically ventilated and then transferred. On exam BP 190/ 116 mmhg. Unresponsive to verbal stimulation.Rt pupil 5mm,nonreacting. Rt eye in the abducted position.No motor response on painful stimulation. DTRS bilaterally hypoactive with unresponsive plantars. Poir prognosis was explained to the relatives and suggested active supportive care. Also evaluated by the Neurosurgeon. What abnormality in the CT Brain with structures involved and the diagnosis

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Concluded answer
ThanksCurofy and all Doctors . Discussion: What abnormality in the Ct and structures involved. * Intraparencymal hematoma,left putamen ,external capsule subcortical & periventricular deep white matter of left frontotemporoparietal region with perilesional edema and mass effect. * Signifocant midline shift 12mm to right. * SAH left frototemporal cortical sulci and left sylvian fissure. * Uncal herniation with rotational displacement of midbrain. * Chronic infarction Rt coronaradiata. * Mild left hemicerebral edema.
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Significant heamotoma ma'am left MCA infarct, extending from the thalamus to the insular slight midline shift, explained by irregular htn. and management, bp needs to be managed although prognosis are not promising but craniectomy might be useful...
Recheck the film carefully. SOME THING MORE THERE. YOU ARE ABLE TO DIAGNOSIS.
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ThanksCurofy and all Doctors . Discussion: What abnormality in the Ct and structures involved. * Intraparencymal hematoma,left putamen ,external capsule subcortical & periventricular deep white matter of left frontotemporoparietal region with perilesional edema and mass effect. * Signifocant midline shift 12mm to right. * SAH left frototemporal cortical sulci and left sylvian fissure. * Uncal herniation with rotational displacement of midbrain. * Chronic infarction Rt coronaradiata. * Mild left hemicerebral edema.
Huge left MCA territory hemorrhage with perilesional edema with some midline shift. Needs labetolol if BP remains high. Craniectomy and hemorrhage evaluation might be useful.
Please recheck the film . Something is more.you ate able to diagnose.
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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!
Thanks Curofy
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Acute cerebral bleed with clot retraction with mass effect with mid line shift with subarachnoid hemorrhage and subarachnoid hemorrhage
I agree
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Acute hemorrhagic stroke involving left gangiocapsular region...with mid line shift.... urgent neurosurgery intervention is required
Thank you doctor
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Significant haematoma in lt MCA infarction,with midline shift ,prognosis poor craniotomy is useful
Thank you doctor
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huge IC bleed surgical decompression with evacuation of haematoma poor prognosis
Big haematoma Lt MCA territory
Thank you doctor
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Rt old infarct also
Thanks. Your observation is correct. I posted the film for the acute one that too ICH with SAH. But our eyes should pick everything.Good.
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