UMEM Educational Pearls

Title: What's the Diagnosis? Image by Dr. Karen Baker

Posted: 12/27/2016 by Tu Carol Nguyen, DO
Click here to contact Tu Carol Nguyen, DO

Question

68 year-old male presents with 3-4 days of hedache, anorexia for 2 weeks and "balance trouble." His blood pressure was 226/140 and he states he has not been on his medications for 6 months.

Physical examination revealed a shuffled gait with his walker and the rest of his physical exam and neurologic exam was unremarkable.

His CT is seen below. What's the diagnosis?

Answer

Answer: Large left cerebellar intraparenchymal hemorrhage with surrounding vasogenic edema with mild infratentorial midline shift of ~4mm

Take Home Points:

Ambulate every patient when doing a neurologic exam (as they can tolerate)
Reverse anticoagulation, if necessary
BP control in intracerebral hemorrhage
- Still exist different opinions with BP thresholds
- 2015 AHA/ASA guidelines: reduction of SBP to 140 is safe
- Refer to a previous pearl for more information

References

Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032-60.