Concluded Case

CSDH WITH HEMIPARESIS

56yrs old male brought in ER in drowsy condition with C/o left sided weakness since 6days and restlessness,H/o Fall on the ground 30days back.Patient is normotensive,nondiabetic No cardiovascular disease.Haemodynamically stable O/e CNS - Conscious but disoriented Pupils - B/l reacting to light GCS - E3V4M5 All vitals parameters normal,COVID 19 ñegative Diagnosis and clinical approach to this patient is there

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Concluded answer

chronic subdual..burr hole evacuation

All Answers

A large subdural haematoma - Traumatic- acute on chronic involving right fronto temporal parietal and occipital region with midline shift, compression of right lateral ventricle and intra- ventricular extension of hemorrhage with significant brain oedema with downward displacement of mid brain. As patient is stable - with fairly good GCS - an early neuro- surgical evacuation of haematoma is indicated before any serious uncal herniation occurs. Prognosis will be good after surgery

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Rt acute on subacute SDH involing frontotemporoparietal convexity with graded signal abnormality ,maximum thickness in te Rt posterior frontal with uncal herniation to left with rotation and downward displacement of midbrain.There is significant brain edema,midline shift and compression of rt lateral ventricle with periventricular T2 hyperintensity in the posterior horm of left lateral ventricle. Suggest urgent neurosurgical intervention.

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Fronto Parietal Burr Hole and evacuation of hematoma

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chronic subdual..burr hole evacuation

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Oedema of brain with tumour or glioma or nystisarcosis do core biopsy HP

Acute on chronic SDH
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