Case of Spontaneous right basal ganglia complex haemorrhage secondary to hypertensive vasculopathy
Dollah Mat Tahir
B194296

Dollah Mat Tahir
B194296

U/L IHD & HPT
80/M

P/w jerky movement of U/L and L/L whilst having dinner at 1830H.

Prior to seizure complain of right sided headache.

Brought to ED via ambulance.

At ed noted BP 222/93
E1V1M3. Pupils 4/4

Given hydralazine

On my assessment

Bilateral hypotonia, hyperreflexia. Babinski upgoing and clonus.
Gag poor

Lungs transmitted sounds

CT brain - massive right intraparenchymal bleed with basal ganglia involvement and midline shift (0.5cm)

Counselled family on poor prognosis.

Daughter refuse for active resuscitation or intubation. Only for comfort care.


Imp : 1)massive right Intraparenchymal Haemorrhage with basal ganglia involvement and midline shift.

2) aspiration pneumonia.


Plan
Admit 2i
Aim normotensive BP (currently normotensive)
IV pantoprazole 40mg od
IV phenytoin 100mg TDs
iv mannitol