Worsening confusion

Chief Complaint A 33-year-old male presents with complaint of worsening confusion for 1 month. History He had a history of headaches for 8-9 months, which has recently increased in frequency for 2 months. No history of any other symptom like fever or weight loss. He had a h/o smoking tobacco and marijuana. Vitals BP: 125/85 mmHg HR: 66 beats/minute Respiratory rate: 20/minute Temp: 97.6˚F Oxygen saturation of 99% on room air. Investigations He was alert and oriented to place and person. All physical examination was normal. His urine toxicology test was positive for marijuana and cocaine. CT brain is attached below. Diagnosis What do you interpret from CT brain? Treatment Please give your comments.

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What about the Neurological exam findings which is important in this case. 2and thing- post the complete films.ypu mentioned CT brain ,but posted 2 MRI films T2w images shows multiple mildly hyperintense lesions left frontal ,rt frontal and bilateral periventricular lesions. ContrastT1 shows left frontal irregular contrast enhancing mass with mild perilesional edema. Contrast film is not the same cut as T2 w image. NEEDS MORE PROPER IMAGES FOR PROPER DISCUSSION. DD WITH LIMITED INFORMATION : Lymphoma , sarcoidosis,Mets,Toxoplasmosis. Do HIV .

Ischaemic stroke with bleeding Long use of marijuana sometimes causes hypertension which is enhanced by cocaine. Physical injury may also be ruled out. Needs further investigation and evaluation to conclude and line of treatment. Neurosurgeon opinion and de addiction management . Regular monitoring and constant evaluation required.

Ischemic stroke with active bleed which spread in 2 nd CT Midline shift with hypodense in basal ganglia possibly bleed 2 nd CT scan hypodense area in grey matter with bleeders Opinion of neurosurgeon Effect of marijuana on hypertension & possibly phenomena

Ischemic stroke with active bleed with midline shift. Get MRI Brain for confirm and clear picture Citicoline 500 bd Piracetam 800 bd Dexamethasone bd Multivitamin Neuro opinion must

Multiple rings and focal oedema ? Inflammatory granulomas ?? Metastasis

Glioblastoma

Yes this is not CT scan picture There is multiple small round and one big lesions It may be toxoplasmosis or multiple abscess or metastases but cant be ischemic stroke. What is HIV status.

Film show active bleed with ischemic stroke with midline shift Control bp And treat accordingly

Case is well described and delineated by Dr. Manorama. Agree with madan

Left frontal hemorrhagic stroke