Concluded Case

INTRACEREBRAL HEMORRHAGE EXTENDING NEAR VENTRICLE/PERIVENTRICULAR

48yrs old male with no significant past medical history presented to ED with Severe right sided hemiplegia and aphasia,the symptoms began approximately 6hrs before arrival to emergency.No travel history or fever,cough or Respiratory illness.O/e - Pupils - Left 7mm SRTL,Right 4mm RTL,GCS - E3VAM4-5,BP -180/90mmhg,PR -73/mt,RR -22.Negative for COVID,ECG normal, Coagulation profile normal,TLC -18000,Hb -9.0 WHAT ABNORMALITY SEEN IN CT HEAD, MANAGEMENT PLAN?

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Concluded answer
Left BG , ic bleed with mass effect. Decompress with evacuation of bleed. Once settled, get angio done.
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Hypertensive & may be aneurysmal ICH bleed in Lt thalamocapsular , temporal lobe compressing Lt lateral ventricle with minimal midline shift & Cerebral oedema. Need Urgent Rx, Neuro team & follow up. SIMULTANEOUSLY team approach . Need urgent interventional Neuroradiolodist & Neurosurgeon & Neurologist opinions. If possible cerebral angiogram and intervention procedure maybe coiling if possible or neurosurgical intervention if possible . Check & maintain ABCDE & vitals. Stop anticoagulant & antiplatelate drugs. Control BP with Labetalol. Sedation, analgesia and Ventilation. Maintain good oxygenation and lower side paco2 . ABG ,with electrolytes, glucose, hb, hct, lactate. Blood x match sos. Analgesic, Antiemetics, Antiepileptic , mannitol . Need neuro ICU observation, monitoring, nursing & nutrition. Repeat CT brain follow up. Need further evaluation, Rx & follow-up.
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NCCT brain shows left thalamo capsulo gangionic bleed with involvement of adjacent tempiral libe and posterior frontal white matter involvement. There is midline shift to Rt with uncal herniation to left. BLOOD IN THE LEFT SYLVIAN FISSURE with sulcal blood in the rt partial sulcus suggestive of SAH. Brain edema lt hemisphere with compression of left lateral and 3rd ventricle. Suggest Neursugery opinion and documentation. Angiogram is needed in view of the SAH .At present pt is critically ill,needs ICU care with ventilatory support,control of BP
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A massive hypertensive aneurysmal rupture hemorrhage left temporal lobe and thalamocapsular region with left lateral ventricle compression midline shift to right and impending uncal herniation. Conservative treatment is needed for 6- 8 hourly to stabilize the patient, lower the B.P to 120 / 80 mmHg with labetalol drip and prepare for surgery as surgical decompression is the only hope of survival
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Left huge IC bleed midline shift Start Anti epileptic Coagulant Mannitol Diamox and Surgical decompression ventilator support
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Lt sided intra cerebral haemorrhage. Midline shift to Rt . Possibly the haemorrhage is extending into lateral ventricle Work up the case .Monitor vital parameters . Mannitol 20 percent infusion over 20 minutes . Dexamethasone 8mg Iv and 4 mg 8th hourly . Lasix 20 mg Iv. Monitor level of consciousness,pupillary reaction . Craniotomy and evacuation of clot once stable .
LT CEREBRAL HGE RX 1 GLYCEROL PO 2 ANTIBIOTICS 3 ANTIEPILEPTICS 4 NO ANTIHYPERTENSIVE RIGHT NOW .. BP WILL COME DOWN AFTER SOME HOURS TO KEEP BP AROUND I50 / 80 ANTIPLATELETS= NO MANNITOL = NO GLUCOCORTICOID = NO O2 INHALATION CARE OF PRESSURE POINTS MOUTH & THROAT TO CLEAR OF SECRETIONS
Ct scan skull shows cerebral haemorrhage lt .required treatment. 1.ryles tube feeding .2.iv fluid normal saline 3.iv glcerol 4.iv cerebral protine 5.iv cetistar 6 .folleys catheterization 7.care of skin 8. Iv b12 9.statin10. Cytogard
Left basal ganglia hemorrhage with mass effect May required hematoma evacuation with or without decompression Repeat ct after 12 hrs or if sensorium deteriorated Control bp and other anti edema measure
Left cerebral bleed with ventricular breakthrough with mid line shift. No need of intervention ?/hypernsive. Pl take care of BP and vitals
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