Concluded Case

Acute SDH hematoma in 70yrs old male

70yrs/F no significant history other than hypertension,fell and refused care family called an ambulance 8 hours post fall, When he arrived to emergency he was in deep coma(decerebrate rigidity),gasping with GCS 4/15,Pupils - B/l Semidilated fixed non reactive to light,BP - 180/90,PR - 120,Spo2 -85%.POOR PROGNOSIS EXPLAINED TO RELATIVES.DIAGNOSIS AND SUGGEST TREATMENT PLAN?

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Concluded answer
Left frontotemporoparietal acute SDH with significant compression of left lateral and 3rd ventricle,severe midline shift with Transfalse Herniation to Rt.Hyperintense lenior lesion left frontal on T1Wwith perilesion edema with involvement of corpus callosum suggestive of left frontal contusions with edema..2nd set of film 1st row ,5th film from above down suggestive of uncal herniation also Left frontotemporoparietal acute SDH with transfalse and uncal herniation. Prognosis looks poor. Decision of Neurosurgeon regarding the evacuation of hematoma. There is big left frontal lesion with corpuscallosum involvement and hence I think surgical out come is poor. Left it for Neurosurgeon.
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This pt have left F'T'P' sdh with frontal hematoma , mid line shift and mass effect present , di chest xray , ecg , send covid test, give cerebral decongestant , anti epileptic drugs , operate this pt immediately if attendent willing for surgery on high risk and death on table , option for surgery can be given , but prognosis is poor , di all blood work up , continue venti support .
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Left frontotemporoparietal acute SDH with significant compression of left lateral and 3rd ventricle,severe midline shift with Transfalse Herniation to Rt.Hyperintense lenior lesion left frontal on T1Wwith perilesion edema with involvement of corpus callosum suggestive of left frontal contusions with edema..2nd set of film 1st row ,5th film from above down suggestive of uncal herniation also Left frontotemporoparietal acute SDH with transfalse and uncal herniation. Prognosis looks poor. Decision of Neurosurgeon regarding the evacuation of hematoma. There is big left frontal lesion with corpuscallosum involvement and hence I think surgical out come is poor. Left it for Neurosurgeon.
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First film - right sided images are T1 weighted images which shows isointensity in left frontal region First film left sided images are T2 weighted images which shows decreased signal in left frontal region It is suggestive of left frontal region intracranial hemorrhage It is causing midline shift , compression of ipsilateral ventricles and dilatation of contralateral ventricles Frontal lobe hemorrhage patient can be salvaged - some times their motor function is also recovered over a period of time Therefore, I would refer it to neurosurgeon and request for aggressive treatment In this case decompression craniotomy
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Case of frontal hematoma See for Chest xray and ecg See for blood routine test Intubate the patient and continue the venti support further management Start Antibiotic/ antiepileptic/ corticosteroids/ anti oedema/ citicholine/ nootrophil and accordingly Patient need urgent neurosurgery opinion And can needed surgery for further management See for covid 19 also
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First of All Intubate the patient admitted ICU, CMV SUPPORT, IT'S A CASE OF FRONTAL HEMATOMA, URGENT NEED SURGERY CONSULTANT NEUROSURGEON & NEUROPHYSIAN, START ANTIBIOTICS, ANTI EPILEPTIC/ANTIHYPERTENSIVE, DIURETIC, MANNITOL 20%, /inj. Citistar/ Inj. Piracetam / Do, bed sided echo or CXR P/A, & Check COVID -19
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Lt frontotemporal huge hematoma Mid line shift Cerebral oedema Leucocytosis Poor GCS Pt is hypertensive and in coma with decerebrate rigidity Iv antibiotics inj Ceftriaxozone Inj dexamethasone 8hrly Antiepileptics Antihypertensives Sos surgical intervention
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Large left SDH with hemorrhagic contusion on left frontal region. Is pt on anticoagulant, why this much high INR ?? Previous history of HTN ?? Pt must be taken for hematoma evacuation urgently
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SUGGESTIVE OF LT... S. D. H... (..LARGE. ..) LT. FRONTAL. REGION ... HEMORRHAGIC CONTUSION... HYPERTENSIVE.. NEEDS. IMMEDIATE. INTERVENTION WITH FURTHER. INVESTIGATION
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I think due to cerebrovascular problem w must decide for surgery for SDH with best hopes. Thanks.
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