CASE PRESENTATION
A 39 –years- male patient presented to our institution with the history
of acute onset of weakness of the right side of the body, deviation of
angle of the mouth to left side, generalized stiffness of the body,
unable to speak and urinary incontinence for which he was evaluated and
managed conservatively in another center. His medical, surgical and drug
history was unremarkable. Family history was irrelevant and history of
trauma was trivial.
On retrospective survey, when he presented to the ER in the other
center, his pulse rate was 98 bpm, blood pressure was 200/100 mm of Hg,
Glasgow coma scale (GCS) was E4 V2 M6, pupils were bilateral equal and
reactive to light. Further neurological examination revealed a decreased
sensation over right side of the body with motor power in the Right
upper and lower limbs was 0/5 and 5/5 in left upper and lower limbs. His
deep tendon reflexes were absent on the right side but preserved on the
left side. Similarly, the plantar reflex on the right side was extensor
and flexor on the left.
Laboratory parameters were within normal limit. CT scan of head revealed
hyper dense lesion involving bilateral basal ganglia suggestive of blood
with volume of 28 cc in left and 13 cc in right (Figure 1). He was then
admitted in an ICU and managed conservatively. There was gradual
improvement in the condition of patient, he was then shifted to ward and
after 9 days of admission, he was discharged and he presented to our
center for further management and advice.
At presentation to our center, GCS: E4 V4 M6, Pupils: Bilateral 2 mm and
reactive to light, Sensation was decreased over right half of the body.
Motor power in the RUL/RLL was 4+/5 and in LUL/LLL was 5/5, deep tendon
reflexes were decreased over right side.
CT head and CTA was repeated. CT head revealed resolving hematoma
(Figure 2). CTA was negative for intracranial aneurysms, vascular
malformations, vasospasm or cerebral venous thrombosis (Figure 3).
When the patient presented to our facility six months following the
first bleed, he was fully oriented to time, location, and person, with
motor power 5/5 in all four limbs and very little slurring of speech and
enhanced emotional drive. He is now able to carry out his daily tasks
alone and has returned to his farm. We took another CT scan of the head,
which revealed a resolving hematoma. (Figure: 4).