Concluded Case

ICH WITH IVH

60yrs old female with no previous h/o HTN presented in casualty in unconscious condition with H/o Sudden LOC following headache n vomitting.Patient is known diabetic × 1yrs O/e GCS - E1M4V1,GCS-P = 4 Pupils - B/L 1mm Non reactive to light Bp - 150/80mmhg Spo2 - 98%

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Concluded answer

Right ICH involving basal ganglia,internal capsule with IVH Suggest: ET Intubation and mechanical ventilation Target PCO2 30-35 Prophylactic antibiotic Anticonvulsants Cerebral decongestants Avoid hypotension Blood sugar control Supportive management EVD insertion Repeat CT after 12hrs BT CT PT 2D-Echo Routine labs

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Right ICH involving basal ganglia,internal capsule with IVH Suggest: ET Intubation and mechanical ventilation Target PCO2 30-35 Prophylactic antibiotic Anticonvulsants Cerebral decongestants Avoid hypotension Blood sugar control Supportive management EVD insertion Repeat CT after 12hrs BT CT PT 2D-Echo Routine labs

I do agree with Dr shehroz -Dr pl focus on prevention&early intervention Awareness among the vulnerable /High risk pts in that area&other identified areas (community service
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A large intracranial hypertensive bleed in the the region of right basal ganglia and internal capsule region with intraventricular extension causing obstruction hydrocephalus. Conservative decongestive therapy is to be supplemented with external ventricular drain to relieve hydrocephalus

Rt parenchymal bleed-rt thalamus noted in the 1set of film 3rd row , 3rd film from above down with perforation in the ventricular system including lateral, 3rd & 4th ventricle with mild hydrocephalus Suggest repeat ct to look for hydrocephalus Neurosurgical opinion

Accelerated HTN leading to CVA.... Large ICH (Right gangliocapsular region) with Intraventricular extension.... Poor GCS Urgent neurosurgery intervention/conservatuve management

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