Concluded Case

Bilateral SDH.Large Left sided SDH with Subfalcine herniation

Right sided grip weakness noted 4 days ago while holding the tea-cup in the morning. The same day evening he developed mild difficulty in walking.Evaluated locally received one IV fluid and he felt better. The next day again noted mild upper limb weakness with mild heaviness in the Rt side.Denied having any head ache ,vomiting or vertigo.On the day of admission ie on the 4th day of illness he developed diffuse headache and vomited once and came to OPD History Known hypertensive and diabetic on med ,under control. Post PTCA on ecosprin 75 mg and clopidogrel 75 mg. History of trivial trauma ,head hit on the door of car about 2 weeks ago but asymptomatic till 4 days ago. Vitals Stable. BP 140/ 86mmhg. Afebrile. Physical Examination Fully concious ,communicating well .Intactcranial nerves.Rt grip weakness .Rt sided power gr4/ 5 ,left5/5. DTRS 3+ rt side 2+ left side with intact sensations. Investigations Routein blood work upincluding biochemistry were normal. ECG - normal. MRI BRAIN - FOR discussion. Diagnosis Is very clear in the MRI .keeping forf discussion Management What is the diagnosis? How will you approach the case.?

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Concluded answer

Thanks Curofy and all other Doctors who answered the case . MRI brain report: * Large left sided acute on chronic SDH frontotemporoparietal convexity with maximum thickness2.5cm. *Rt sided acute on chronic SDH with maximum thickness 1.2 cm. *Mass effect in the formnof effacement ofall the cerebral sulci with midline shift1.4cm to Rt. * Displacement & rotation of mid brain & cerebral peduncle to Rt. * There is subfalcine and descending transtentorial herniation to rt. Left fronto temporo -parietal burrhole craniectomy done.pt is better.

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Its acute on chronic Sub dural haematoma bilateral. Needs decompressive surgery and seizure prophylaxis.
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Thanks Curofy and all other Doctors who answered the case . MRI brain report: * Large left sided acute on chronic SDH frontotemporoparietal convexity with maximum thickness2.5cm. *Rt sided acute on chronic SDH with maximum thickness 1.2 cm. *Mass effect in the formnof effacement ofall the cerebral sulci with midline shift1.4cm to Rt. * Displacement & rotation of mid brain & cerebral peduncle to Rt. * There is subfalcine and descending transtentorial herniation to rt. Left fronto temporo -parietal burrhole craniectomy done.pt is better.

Mild pyralasis stroke give you manital iv infusion

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its SDH need neurosurgery

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Subdural hematoma left frontoparietal area,surgery needed

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Acute on chronic subdural hematoma

Needs evacuation
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SDH Inj. Manitol Inj Dexamethason Antibiotics along with supportive tt If there's no improvement for one week then decompressive surgery should be done

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? SDH Decompressive craniotomy..

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Decompressive craniotomy

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SDH with midline shift, needs surgical evacuation

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