SPONTANEOUS ICH OCURRING DURING PROGRESSION OF CSDH

A 63yrs old man was admitted to the emergency depmartment due to vomiting,followed by quadriparesis. The patient was healthy before admission and his medical history was unremarkable.He had a 2month history of minor head trauma as a result of fall to the ground He suffered from headache. He was observed at home, until a relapse of headache and quadriparesis, followed by neurological deterioration, led him to be transferred to hospital two months after trauma. On admission, the patient was stuporous with GCS 11 (E3V3M5), and motor examination revealed Right hemiparesis (grade 1/5) and left hemiparesis (grade 3/5). Pupils were equal and reactive to light. Blood pressure was 190/100 mmHg.PATIENT RELATIVES NOT WILLING FOR SURGERY. Chief Complaints Vomitting, headache, Quadriparesis History HTN Vitals BP -190/100,Spo2 -99% on RA,RR -22,HR -109 Investigations Hb -9,TLC -17000,Na -125,K -4.5 Coagulation profile normal Diagnosis SICH AND CSDH Management MANAGEMENT PLAN?

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Chronic Sub dural haematoma with acute hypertensive left paraventricular and intracerebral bleed with extension of haemorrhage in the ventricles - which possibility of impending secondary hydrocephalus. If patients- attendants are not willing for surgery - then conservative treatment indicated is Gradual lowering of blood pressure Decongestive therapy with mannitol AED,s Oxygen support with mask IV fluids If condition deteriorates then ventilatory support and surgery is indicated

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Rt frontoparietal Chronic SDH with mild hyoerintensity rt frontal and rt parietal are suggestive of small acute bleed. Left putamino caudate bleed with blood in the left lateral ventricles ,3rd and 4th ventricle. Rt sided SDH needs evacuation ,try to convince the relatives about the need for burrhole evacuation,if not willing documents things in the medical record. Control BP ,supportive ,management.

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Old right subdural abd acute left paraventricular bleed with ventricular breakthrough

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SDH, can control conservatively with Inj. Neurocetam 2 amp twice a day Inf. Mannitol twice a day Tab. Fefol 5 mg once a day With other symptomatic Rx along with strict vital monitoring. To control headache inj. Phenytoin can be used.

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Rt side subdural hemorrhage..ll to reduce bp we should reduce intracranial pressure by burr hole..ll reffer this case to neurosurgery/intensive care deptt

Relatives not willing for surgery
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ventricular drain

Patient has old right sided SDH with acute left sided paraventricular hemorrhage extending to IVH PT requires surgery

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