Concluded Case

Massive intracerebral hemorrhage with collection of blood in contralat

66yrs/M with a long H/o HTN suddenly fell at home and was unable to move his left side body presented to casualty with impaired consciousness GCS 4/15,Pupils - B/l 8mm NRTL,BP - 200/100,PR - 50.,Received intubation from outside hospital.WHAT ABNORMALITY SEEN IN CT?

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Concluded answer
Large right thalamic ICH with intraventricular extension, suspected etiology hypertensive bleed given history and location. With GCS 4, ICH volume, and IVH, ICH score = 4, which correlates to roughly 97% 30 day mortality. Manage by ABCs, keep SBP<150, correct any coag abnormalities if present, but also prepare the family that the outcome is unlikely to be favorable.
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A massive hypertensive bleed most likely a rupture of aneurysm - involving right frontotemporo- parietal region , right basal ganglia and extension of hemorrhage into lateral ventricles , SAH with interhemispheric extension. Also there is uncal herniation of the opposite side and a poor prognosis. Patient is having raised urea and creatinine- indicative of either pre-,existing hypertensive nephropathy or as part of acute renal shut down. ABG studies indicates increased PO2 - 143 - not proper ventilatory support and hypokalemia- which requires potassium replacement. Blood pressure needs to be lowered slowly to 130 / 80 mmHg and not below this with labetalol in drip . Conservative treatment meanwhile to be started with maintaining input / output considering uraemia with indwelling catheterization. Decongestive therapy, AED'S, inj Pantoprazole, IV fluids, proper ventilatory support. Only if patient improves - which is unlikely- neurosurgical consultation may be indicated
Rt putamino capsulothalamic hematoma with involvement of white and grey matter of rt frontotemporo parietal area with transfalse and uncal herniation to left.Extension of bleed to the lateral ventricles with sulcal diffuse SAH with interhemispheric blood . Extremely poor prognosis.
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Acute cerebral bleed with ventricular breakthrough
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Large right thalamic ICH with intraventricular extension, suspected etiology hypertensive bleed given history and location. With GCS 4, ICH volume, and IVH, ICH score = 4, which correlates to roughly 97% 30 day mortality. Manage by ABCs, keep SBP<150, correct any coag abnormalities if present, but also prepare the family that the outcome is unlikely to be favorable.
Haematoma left side
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