Concluded Case

Cavernoma left caudate nucleus with acute- subacute hemorrhage

34 yr ,M, suudden onset vertigo, vomited once and then then developed head ache over the vertex 3 days ago with out any back ground history of medical illness. Chief Complaints Three days ago while watching the news ,suddenly he developed subjective vertigo,vomited once.After vomiting sudden throbbing head ache over the vertex. At the time of vertigo, he could not move and he remained seated and closed the eyes. After 2 hrs he became perfectly alright. He attended the OPD on the 3rd day and stated that he had a horrifying experience 3 days ago .Denied having any previous history of vertigo or head ache.No motor or sensory symptoms. History No previous history of any medical illness. Non smoker,not in the habit of taking ethanol. Family history is non contributory Vitals Afebrile, BP 120/ 80 mmhg.Hr 72/ mt. Physical Examination Normal higher function,speech, optic fundi and cranial nerves. NO long tract signs. No neck stiffness. Investigations ECG - normal.Badic blood work up - normal. MRI brain- keeping for discussion. Diagnosis Diagnosis is obvious in MRI brain ,keeping for discussion. Management Ref the case to interventional Radiologist. Suggested Rept MRI with MRA after 3 months. Currently on Leviteracetam. Diagnosis and management??

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Thanks Curofy and others who answered the case. MRI brain : * Fairly well defind intra-axial SOL in the head of caudate nucleus with MRI signals and susceptibility artefactsin SW1.Mild perilesional vasogenic edema and mild oeriledional contrast enhancement. Features represent CAVERNOMA WITH ACUTE- SUBACUTE HEMORRHAGE. * Lesion closely abutting and compressing the frontal horn and body of lateral ventricle. No evidence of ventricular dilatation * No evidence for AV M on MRA.

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Thanks Curofy and others who answered the case. MRI brain : * Fairly well defind intra-axial SOL in the head of caudate nucleus with MRI signals and susceptibility artefactsin SW1.Mild perilesional vasogenic edema and mild oeriledional contrast enhancement. Features represent CAVERNOMA WITH ACUTE- SUBACUTE HEMORRHAGE. * Lesion closely abutting and compressing the frontal horn and body of lateral ventricle. No evidence of ventricular dilatation * No evidence for AV M on MRA.

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According to me brain Tumer,Thunderclap headache A thunderclap headache is an extremely severe headache that comes on rapidly. It’s sometimes called a lone acute headache. It develops in 60 seconds or less and causes intense pain. Thunderclap headaches can be caused by bleeding in the brain after an arterial aneurysm rupture, stroke, or other injury. Pain from thunderclap headaches might occur anywhere on your head and extend to your neck or even areas of your lower back. The intense pain can last for an hour or more, and might be accompanied by dizziness, nausea, or loss of consciousness. Meningitis, encephalitis, and brain tumors can cause thunderclap headaches. Hypertension is a more common cause. The treatment for this kind of headache will depend on the cause. It’s important to immediately if you have a headache that reaches peak intensity in a minute or less and doesn’t Surgery

AV malformation with ventricular and parenchymal bleed.

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