Investigations and treatment:
A non-contrast brain CT was done immediately which demonstrated
bilateral basal ganglia bleeding (figure 1 and 2) . CT cerebral
angiogram (figure 3) was negative for aneurysms and vascular
malformations. Blood samples were withdrawn and sent for complete blood
count, coagulation profile and biochemistry and were found to be within
normal limits. A 12-lead electrocardiogram was obtained and showed
normal sinus rhythm and left ventricular hypertrophy(LVH). An x-ray film
of the chest didn’t pick out gross cardiopulmonary abnormality. Patient
was shifted to the intensive care unit and was managed with a
combination of antihypertensive, osmotic diuretic(mannitol) and other
supportive intravenous and oral medications. Nasogastric tube was
inserted and early enteral feeding was started. While in ICU,
echocardiogram and ultrasound scan of abdomen with renal doppler was
performed bedside. ECHO was normal except for the presence of concentric
LVH and ultrasound scan was unremarkable. The patient gradually improved
over the period 6 days with GCS of 14 (E4V4M6) and controlled blood
pressure with a combination of anti-hypertensive drugs. He was then
shifted out of the ICU and was taken care of in the ward along with
physiotherapy and other supportive therapies.