Concluded Case

Sub acute hemorrhage on chronic/ subacute SDH left frontoparitotempora

New case. 39 yr F,Staff Nurse,working at Kuwait,no lnown comorbidities, arrived 3 months ago,presented with left sided holocranial head ache since 1 week.Almost continuos head ache,mild relief with paracetamol.No visual symptoms / nausia. On 8th of this month she vomited once and hence admitted. 3 werks ago she fell down from 2 wheeler,got up immediately with out any injury,but evaluated at local hospital. On examvital stable. BP 120/ 80 mmhg. Preferring to sleep but easily aroused. Optic findi normal. Moving all limbs spontaneously. No focal deficits. Emergency treatment given including Surgical procedure after the CT brain. Patient is well stable. What abnormality in the CT brain?. What emergency procedure she had undergone ?

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Concluded answer

Ct shows * large mixed density SDH overlying the left frontoparieto temporal convexity with posterior dependent layering of hyperdensities . * Significant mid line shift to right with mass effect. * Descending transtentorial and falcone herniation . * Diffuse cerebral edema. Impression: SUB ACUTE HEMORRHAGE ON CHRONIC/ SUBACUTE SDH Emergency frontoparietal burrhole craniectomy done and she is recovering,plan to discharge tomorrow.

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Ct shows * large mixed density SDH overlying the left frontoparieto temporal convexity with posterior dependent layering of hyperdensities . * Significant mid line shift to right with mass effect. * Descending transtentorial and falcone herniation . * Diffuse cerebral edema. Impression: SUB ACUTE HEMORRHAGE ON CHRONIC/ SUBACUTE SDH Emergency frontoparietal burrhole craniectomy done and she is recovering,plan to discharge tomorrow.

A large left sided chronic sub dural haematoma extending from frontal to temporo parietal and occiptal region with midline shift and compression of left lateral ventricle. An emergency burr hole craniotomy and evacuation of haematoma has been done

Ohh this is significant chronic SDH with midline shift.. Was she on any medications? She must be doing great after burr hole and hematoma evacuation !

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Obstructive hydrocephalous Cerebral oedema Midline shifted to right Surgical intervention by Neurosurgeon to reduce intracranial pressure

Film shows chronic SDH with oedema See for blood report and eeg See for ecg And treat accordingly with anti oedema and corticosteroids

Oedema of brain tissue with midline shift... need to ruleout encephalitis. Agree with Dr. Anand Kumar’s opinion ...

Left subacute subdural heamatoma with mass effect with mid line shift with obstructive hydrocephalus

Hematoma evacuation with ventriculostomy.

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