Concluded Case

BASAL GANGLION BLEED

58yrs/M Uncontrolled Type 2 diabetic with HbA1c 12 developed Acute onset dysarthria and left side monoparesis with slurred speech.His GCS on hospital arrival was 14/15 with blood pressure reading of 180/100.N/h/o Headache, vomitting and seizure. Chief Complaints Left sided weakness (UL > LL),Slurred speech History HTN,T2DM Vitals BP -180/100,HR -79,RR - 23,Temp - Normal Physical Examination GCS -14/15,Pupils -B/l RTL,Power Left UL -0/5,LL -5/5,Right UL -5/5,LL -5/5 Investigations HbA1C -12,RBS -450,Hb -11,TLC -11k,PT,INR - Normal.

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Concluded answer

Hypertensive Intracranial Bleed Right Basal Ganglia leading to left upper limb monoplegia... Treatment will be conservative including BP reduction of not more than 20% during 1st hour f/b usual Intensive care for acute stroke patients... Judicious control of b. sugar

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Right basal ganglia hypertensive bleed The putamen is vascularized by the lenticulostriate arteries (LSa). The LSa are small diameter end vessels that originate at a right angle from the artery of Charcot without the gradual stepdown in size that occurs in the distal cortical vessels. Their internal pressure may be very high and for this reason the LSa are particularly susceptible to damage from hypertension. Adv Intensive BP reduction (target BP < 140 mm Hg systolic) early in the treatment of patients with intracerebral hemorrhage appears to lessen the absolute growth of hematomas Intravenous Nitroglycerin infusion to reduce blood pressure to target of 160/90 mm of Hg Prophylactic anticonvulsant therapy Check for PT PTT and INR - correct coagulation abnormality Strict control of diabetes with insulin and if required infusion of insulin

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A hypertensive bleed right basal ganglia regipn causing opposite side i.e.left side paresis .. Considering no other cerebral lesion - prognosis is good . Conservative treatment remains the mainstay of treatment 1.Gradually lower the B.P with labetalol in drip 2..Decongestive therapy with mannitol , AED'S, IV fluids, input / output chart 3.Achieve strict glycaemic control with insulin. 4.Stop Aspirin or Clopidogrel- if patient is taking 5.Tab Piracetam + citicholine B.D for 1 month

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Basal ganglia hemorrhage is a common form of intracerebral hemorrhage, and usually as a result of poorly controlled long-standing hypertension. Other sites of hypertensive hemorrhages are the pons and the cerebellum. And see all report And treat accordingly

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ICH rt lentiform nucleus in uncontrolled DM & HTN Control DM with Insulin Strict dietary control Control HTN Diuretics Citicholin & Pyracetum Maintain electrolytes Antiepileptic drugs under consideration

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Right capsuliganglionic hemorrhage with seepage into ventricle Control of BP, tight control of DM with insulin, anti edema measures, anti seizure medications,

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Diabetic and hypertensive pt uncontrolled reporting with acute onset of monoparasis with dysartheria Scan shows acute infarct in rt basal ganglia and internal capsule Control diabetes with basal bolus insulin Gradual lowering of bp inj clexan sc Inj dexamethasone 8hrly Rest supportive treatment

Sir,there is no infarct seen in CT brain
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Hypertensive Intracranial Bleed Right Basal Ganglia leading to left upper limb monoplegia... Treatment will be conservative including BP reduction of not more than 20% during 1st hour f/b usual Intensive care for acute stroke patients... Judicious control of b. sugar

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!

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!

Dm uncontrollable Pt awake Rt thalamic haemorrhage Consult neurosurgeon

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