Acute on Chronic SDH

56/F presented to ER with history of developed giddiness and fall 2 days back at her residence. h/o difficulty to stand and walk since then. h/o slurring of speech present. h/o weakness of right upper and lower limb since yesterday. known DMT2, HTN on treatment known CeVD - old CVA right hemiparesis on 2015 o/e conscious but drowsy BP:130/90mmhg. HR:76/min SPO2:98%in RA TC:15,700. RBS:555. urea:96 creatinine:2.3 urine complete: sug +++ alb:+ and 20-25 pus cells and motile bacteria ++++ HbA1c:10.84% Diagnosis and Treatment??

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Subdural hematoma lt frontoparietal hemispheres Past h/o CVA History suggest uncontrolled diabetic RBS555 hba1c10.84% TLC suggest leucocytosis with urinary infection KFTS are deranged From above picture it appears pt is is vary critical with vary poor prognosis Meticulous approach is needed Control sugar put pt on insulin pump Treat urinary infection with broadspectrum antibiotics like piperacillin and tazobactum Inj ofloxacin Inj lasix Assess renal condition as likely diabetic renal pathology Manage Sdh Monitoring Opinion of neurologist
Thanx dr Pushkar ji Bhomia
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Left frontotemporoparietal acute on chronic SDH with early compression of left lateral ventricle. There is thin rt side frontotemporoparietal chronic SDH. There is left seded volume loss with periventricular hypointensity siggestive of residual of old stroke. Also interhemispheric SDH. Suggest Bilateral burrhole evacuation.
Thank you doctor
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Lt frontotemperoparieto-occipital SDH Decompression with Mannitol Antiepileptic Surgical intervention if Covid does not make any further deterioration
Subperiosteal hammrhage Lt fronto parital region Causing pressure over the cerebral cortex Ad ref to neurosurgeon
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SDH left FTP area with midline shift. Control DM, HTN etc and surgical decompression at the earliest
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Left hemisphere Chronic SDH Neurosurgery consult for Burr hole
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Chronic sdh with midline shift ,need urgent surgery asap
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Lt.SDH with uncontrolled DM with UTI

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