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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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

Valuable opinion
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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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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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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!

Thank you doctor
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RT temporoparietal hyoerdense lesion with perilesional edema..adv- Contrast MRI Brain

Thank you doctor
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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 ..

No infarct
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bleed with significant edema. probably needs decompression

It looks like Menningioma , second possibility hematoma Need Radiologist opinion,MRI Referred to neurosurgeon

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