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

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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

Valuable opinion
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Tumour rt parietal region,obstructive hydrocephalus, undergo radiation, surgery

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

Thanx dr Suresh Kumar
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tumor tumor bleed bleed bleed with av malformayion meningioma HU values

Meningioma

Acute edh rt parietal region

It should be drain

Bleed

bleed with significant edema. probably needs decompression

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 ..

No infarct
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