Concluded Case

Acute on Chronic SDH ,left fronto-temporopariel convexity.

New Case 83 yr old , M, apparently fine till 4th of this month, normally walking & talking .On 5th morning he noted difficulty to get up by himself.With help he got up, went th the toilet and while getting up from toilet he fell down due to RT sided weakness. No known trauma to the head . The only med he is taking is 25 mg Losartan for 2 months.Examination showed Rt sided hemiparesis with gr 3/ 5 power What abnormality in the CT brain ?How will you manage the cade?

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Concluded answer

Ct shows blood fluid density left frontotemporo parietal convexity with midline shift to rt with brain edema compressing the left lateral ventricle. Fronto parietal burrhole evacuation done ,pt was discharged on the 4th post op day in a stable state.

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Super seniors will in majority will have shrunken brain creating 1-2 inch space around the brain. If we remember anatomy brain is virtually hanging from the vessels , these vessels are fragile. All whiplash movements at neck create some time leak in brain followed with oedema. We get varietes of findings. All Supra seniors must be belted and sit in car in rear seat. Not to travel on cycle two/three wheeler . High impact movement at home. Carefully implement exercise process. Avoid anger , constant cough sneeze. Sudden rise in abdominal pressure. Not to venture on steps without support. Think 10 times before head neck massage. This info is based on 40 Supra senior patients where 10% only survived.

Left hemisphere acute on chronic SDH with MLS with subfalcine herniation and gross cerebral oedema. Management - stabilisation, Evacuation of clot to be removed by burrhole, Maintain good hydration post op.

Lt massive SDH with median shift Urgent evacuation of haematoma But Mam as you say no h/o trauma...it's confusing to me. Mam I shall wait to know the right answer Mam.

Acute on chronic subdural hematoma with significant MLS. Double burr hole evacuation and drainage is needed. Hemiparesis will improve significantly

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Left frontoparietal a acute on chronic SDH with midline shift. Urgent neurosurgical.intervention and draining of the SDH

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Hypertensive SDH, can occur spontaneously without obvert injuries, as happen in ICH.

Lt acute on chronic SDH with mid line shift

TPA with in 3 hours

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New Case Curofy

ICH....SDH..

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