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 Blood samples were withdrawn and sent for complete blood count, coagulation profile and biochemistry and were found to be within normal limits.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.