Morning Report

ivh + edema cerebri

 History Taking
 Male 53 yo admitted to hospital with chief complain unconciousness

1 day before admission At admission

• The patient was suddenly unconscious • Unconscious

± 1 days before admission. Before that, • weakness in the left extremity
The patient complained a severe • slurred speech
headache, a headache on all parts of the
head and felt weakness in the left Vomit (-), seizure (-), fever (-)
extremity, and slurred speech. He
seemed sleepy but still can be
awakened when he called by his family.
History of Past illness

 History of stroke (-)

 Hypertension ± 2 years ago, controlled with
amlodipine10mg
 DM, Heart Disease, and kidney disease were denied.
 History of trauma of head 1 weeks ago
 Smoking habit ± 40 years ( 1 pack a day )
 Alcohol habit +
 Physical Examination
 General examination:
 General condition: moderate, Consciousness : somnolen
 BP: 150/90 mmHg, MABP : 110 HR: 88 x/m reg, RR: 24 x/m , T: 36.5
°C, SaO2 : 98%
 Conjunctiva : pale (+/+), sclera ikteric (-/-)
 JVP ; normal
 Thorax : Rale -/-, Wh -/-, heart sound I/II normal, gallop -, murmur –
 Abdomen : Flat, normal turgor, peristaltic normal
 Extremities : warm acral
 Neurological Examination
 GCS E3M5V4, PERRL +/+, ø 3 mm/3 mm
 Meningeal Sign: nuchal rigidity (-) Laseque >70/>70 Kerniq
>135/>135
 Cranial Nerves: paresis N.VII UMN sinistra impression
 Motoric State : hemiparesis sinistra impression
MT : N ↓ PhyR : ++/++/++ +/+/+ PatR :- -
N↓ ++/++ +/+ - -
 Sensoric State : can’t be evaluated
 Autonomic State : incontinesia urine et alvi -
 GMA : SH
 SSS : (2.5x1)+(2x1)+(2x0)+(0,1x90)-(3x0)-12 =
1.5 (SH)
WDx
 Unconsciousness ec Cerebral hemorrhage onset 1st day
 Hypertension grade I
 Planning
 Family CIE
 O2 2-4 lpm via canule nasale
 Bed rest + head elevation 30 degree
 Mobilization lean to right/left every 2 hours
 Oral hygiene + chest physiotherapy
 Attach NGT, Cateter ( Family approval )
 IVFD NaCl 0.9% 500cc  21 gtt/mnts (macro)
 Paracetamol 3x500mg via NGT
 Ranitidine 2x50mg iv
 Lactulose syr 0 – 0 – II C via NGT
Diagnostic Planning
 Blood exam
 ECG
 Brain CT Scan
 Laboratory Examination
 Hb : 7.0
 Ht : 23.9%
 WBC : 10.500
 PLT : 358.000
 RBC : 2.00 x 106
 SGOT : 51
 SGPT : 37
 Ureum : 4.1
 Creatinine : 1.3
 Blood sugar : 101
 Na : 131
 K : 4.00
 Cl : 107.0
 OSM : 285.30 mOsm/L
 PT : 0.92x
 INR : 0.9x
 APPT : 0.77x
ECG
 Normal sinus rythm
Brain
CT Scan
Brain CT Scan (zoomed)
WDx
 Unconsciousness ec Cerebral hemorrhage onset 1st day r/
frontotemporoparietal dextra vol ± 105cc + IVH + edema
cerebri
 Hypertension grade I
 Anemia (7.0)
 Hiponatremia (131)
Added Therapy

 Manitol 20% loading dose 300 cc  TD >130/80

mmHg & Osm N, Hb > 10
 Tranexamat acid 3x1gr IV
 Salt caps 3x1
 Consult to internist
 Consult to neurosurgeon
THANK YOU