TUMOR OR BLEED??DIAGNOSIS AND SUGGEST FURTHER MANAGEMENT PLAN?
70yrs/M presented to emergency department due to fall from height following generalized tonic clonic seizure,His past medical history was associated with a prolonged morning headache, which was generalized, dull, non-radiating associated with nausea for the last four months. Chief Complaints Seizure,Left sided weakness, vomitting History Seizure,Headache Vitals BP -120/80,HR -98,Spo2 -98% on room air,RR -18 Physical Examination Confused with incoherent speech,power was 2/5 in both upper and lower left limbs, and coordination was intact with reduced sensory sensation. Her toes were down going, and the reflexes were also reduced on the left side of the body. ,Puipls - B/l 4mm RTL,GCS - E2V3M3-4 Investigations Awaited Diagnosis SOL Management Antibiotics,Mannitol,Dexa,levitracetam,Epsolin started.NEUROSURGERY OPINION DONE
A case of right temporo parietal hyoerdense well demarcated lesion with significant perilesional oedema ,midline shift to left and compression of right lateral ventricle D/ D, 1.Haemorrhage with perilesional oedema- AV malformation rupture 2.Glioma with internal Haemorrhage 3.Calcified cavernous angioma, 4.Meningioma, Needs a contrast MRI scan for further evaluation to plan for surgery with neurosurgical consultation
Hyperdense uniform density well demarcated lesion,Rt posterior temporal and anterior parietal with perilesional edema and compression of rt lateral ventricle.No hyperosteosis noted.Density look like bone dentity but difficult to say unless one measure the HF units.Bone window is not posted also. Look like calcified lesion but difficult to say with out the HF units. SUGGEST RADIOLOGY OPINION. ? CAVERNOUS ANGIOMA CALCIFIED. ????Meningioma
It is SOL on rt side parietal lobe and huge in size compressing all three ventricles on rt side it is extravasetion from ventricles in adjoining brain confusing with bleed Symptoms like headache of excruciating nature a/w vomiting with lt side hemiparasis is consistent with lesion Correct line of treatment Take an opinion of neurosurgeon and plan for surgery
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!
tumor tumor bleed bleed bleed with av malformayion meningioma HU values
Rt subdural haematoma in rt parietal region Opinion of neurosurgeon Craniotomy & decompression craneictomy
Rt Tempo-parietal infarct . Maintain A B C Then, Mannitol 100ml tds Eptoin 100mg tds Dexa 1amp bd Emset 1amp bd Tramadol 1amp Im bd Pan 40mg iv bd Strts immediately.till further investigation awaited ..
bleed with significant edema. probably needs decompression
It looks like Menningioma , second possibility hematoma Need Radiologist opinion,MRI Referred to neurosurgeon
Cases that would interest you
- Login to View the image
A 30yrs old male presented to ER with H/o stabbing right TemporoParietal headache since a year associated with dizziness.At the time of presentation patient had multiple episode of convulsive seizures. O/e - Semiconscious, disoriented,No focal neurological deficit,Pupils - Left 4mm RTL,Right 6mm SRTL,GCS - 11/15. DIAGNOSIS AND APPROACH??
Dr. Prashant Ved1 Like6 Answers - Login to View the image
12/m p/w headache , b/l ptosis and binocular diplopia since 8 months insidious onset gradually progressive no h/o fever , cough, d/d management
Dr. Anand Kumar2 Likes21 Answers - Login to View the image
65 yrs male brought to ER with unresponsiveness state. GCS e1v1m3. pupils bl/ns/sr. interpret the image and management?
Dr. Yaseng Pegu3 Likes20 Answers - Login to View the image
A 75 year hindu male, former Indian army, presents to medicine OPD with complaints of headache(generalised, moderate on severity, without any radiation, without any aggravating factors, continuously present all over the day, ) for 30 days, exacerbated for 2 days, and generalized weakness and loss of appetite for 30 days. No history of fever, vomiting, cough, burning micturition. No history of trauma. No history of visual or auditory disturabances. No history of loss of consciousness or abnormal body movements. No history of discharges from ear or nose. No history of auditory visual or tactile hallucinations. On examination, CNS examination doesnt reveal any abnormality. Power in all limbs is 4/5. Motor reflexes are all present . Various investigations were done , including CT head which is presented in above photographs. what is your d/d?
Dipesh Poudel6 Likes14 Answers - Login to View the image
56yrs/F presented to ED with Complaints of Holocranial headache of 2 months duration, drowsiness, excessive sleep.Past H/o B/l TKR(2015), Hysterectomy 10yrs before,Known/c/o OSA,T2DM,RA× 10yrs..Patient had focal seizure and respiratory distress,so intubated in triage *Chief Complaints* Headache, drowsiness, excessive sleep *History* H/o B/l TKR(2015), Hysterectomy 10yrs before. *Vitals* Bp -110/70,Pulse -82,RR -22,Spo2 -88% *Physical Examination* GCS - E1M4V1 on presentation,Pupils - B/l 2mm RTL,Power - 5/5 right upper and right lower limb,2/5 left upper and 3/5 left lower limb,Plantar B/l upgoing,Chest - B/l clear *Diagnosis* Diagnosis? *Management* Suggest management plan?
Dr. Prashant Vedwan2 Likes14 Answers
2 Likes