Concluded Case

ICH + SAH + Acute respiratory acidosis

26yrs/M presented with Sudden onset of severe headache, vomitting and decreased conscious level with altered sensorium.O/e - Semicomatose,left sided hemiplegia present,Pupils -B/l Normal size sluggish reaction. GCS - E2V2M4,BP - 180/90mmhg,PR -110.Meanwhile,the patient was deteriorating and GCS drop to 3/15.Intubated and put on MV,Pupils - B/l, Dilated fixed non reactive to NEUROSURGEON EXPLAINED POOR PROGNOSIS DIAGNOSIS AND SUGGEST MANAGEMENT PLAN?


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Concluded answer
ICH + SAH + Midlineshift & probably herniation caused the deterioration , as for the management , i think it is supportive only.
All Answers
Parenchymal hematoma rt tempirofrontal with bood in the sylvian fissure rt side,sulcal blood rt fronraland parietal,interhemispheric blood ,with blood in the tentorium cerebelli.There ismidline shift with uncal herniation to left.posterior horn of left lateral ventricle is started dialating. SAH WITH PARENCHYMAL BLOOD WITH MIDLINE SHIFT AND UNCAL HERNIATION TO LEFT.Rt MCA aneurysm is possible. Suggest supportive management at this stage.
Valuable opinion
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Thank you doctor
Right aneurysmal bleed with midline shift . Early angiogram f/b surgery was the only option . Alas ,explaining poor prognosis is ur only option left now
IC Bleed GCS is poor No use of interventional management at this stage Cont medical management- venti support,Mannitol, Anticonvulsant,3%ns,citicoline
Rt side SAH with parenchymal bleed. With midline shift to left. As the brainstem reflexs are absent, prognosis is to be explained.
Valuable opinion
Acute right cerebral bleed with mass effect with mid line shift
A possible right middle artery aneurysmal hemorrhage in the right temporo- frontal cerebral parenchyma with gross midline shift , compression of right lateral ventricle and opposite uncal herniation. There is associated hemorrhage in hemispheric region , tentoreum cerebelli and SAH . As GCS is 3 with bilateral fixed non- reactive pupils - brain death is imminent and difficult to save the patient. Attendants can be counselled for organ transplantation
It's ic GCS is 3/15 no change to revive the patient.if ic bleed more than 4cm patient is going to die.max. u can do is mannitol .iv antibiotics, maintain haemodyanamics
ICH + SAH + Midlineshift & probably herniation caused the deterioration , as for the management , i think it is supportive only.
Adequate ventilation and repeat ct ,early tracheostomy if poor gcs prevails ,evd if possible will improve .
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