58 years old known Diabetic n hypertensive male on irregular medication. O/e - GCS : E3VAM6 Pupils : B/l 4mm RTL Left hemiparesis Pulse : 72/min BP : 180/90 mmHg Temp : Normal,RBS -400mg/dl H/L : NAD PLAN OF ACTION? If conservative what would you prescribe and why? If surgery what would you do?

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Rt Gangliocapsular hemorrhagic stroke Probably hypertensive With mild edema and slight midline shift I would like to manage conservative 1st with cerebral decongestant full dose with good glycemic and bp control at stroke unit. Strict vigilant on gcs, pupil, and power monitoring If any time there is dip in gcs or repeat ct after 24 to 36 hour show increased in hematoma volume or increased edema or midline shift with push for hematoma evacuation with/without decompression.. Pt is having good prognosis with adequate management plan and good care..!!
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Cva: right sided ich with score 2-3 Conservative treatment with an anti epileptic iv mannitol and anti emetic. Because blood itself is epileptogenic so antiepileptic Mannitol to decrease intracranial pressure and yes injection insulin s/c for t2dm Surgery can be performed as the gcs is above 8. Advice CT ANGIO
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Gangliocapsular bleed with ipsilateral compression of ventricular system. Conservative at present..Control BP ,control metabolic parameters,rept ct 12 to 24 hrs.NeedsICU observation. NEUROSURGICAL OPINION
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Rt. Gangliocapsular bleed manage conservatively first manage BP, BP charting needs to be done every hour repeat CT every 24 hours and patient needs to be admitted to icu, can seek neurosurgeons advice..
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Surgery not recommend, as the bleed is deep. Conservative and operative have almost same results as per STITCH trial and other studies too. So, conservative is the way forward.
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Hematoma in rt capsuloganglionic region. Treat conservative with mannitol to decrease cerebral edema..treat hyperglycemia with insulin, treat for htn .
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Acute Rt parietal cerebral bleed with edema with mild mid line shift.. Mannital 20%, Citicolin , eptoin, TelmaM , MVI , Insulin ,
Continue conservative management
Thank you doctor
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Right sided intracerebral haemorrhage Gangliocapsular or temporal region with compression of ipsilateral lateral ventricle with perilesional cerebral oedema, slight midline shift. Needs conservative treatment considering the the depth of the bleed where results of the surgery can do more harm 1.Needs control of B.P with labetalol in drip slowly 2.Stop Aspirin or clopidogrel if at all taking 3.AED'S 4.Considering RBS - 400 - insulin after dose titration to be started 5..Mannitol 100 ml × 8 hourly 6 IV fluids- maintenance fluid 7.Inj Pantoprazole to prevent stress ulceration 8 Oxygen support with mask as oxygen an decrease ICP 9.Catheterisation with maintenance of input output and vitals
Repeat CT head Present GCS - E3VAM6 BP under control by Anti Hypertensive @Manorama Rajan mam,@Dr. Yashesh Dalal sir,@Parveen Yograj sir,@Abhijit V sir,@Anand Kumar sir,@Hardik Ahuja sir.
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