study_ing
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i recently came across a q in which i got confused btw the answer choices putamenal hemorrhage and SAH...the pt was also described to have a lateral gaze paralysis. cud anyone please help me with the CLINICAL clues which wud help differentiate the two?
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| study_ing
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also the significance of the gaze paralysis please
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| msyamp
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- Subarachnoid Heamorrhage
- Focal neurological findings may include the following:
- Cranial nerve deficits: Oculomotor palsy (posterior communicating artery aneurysm) is most frequent. Abducens palsy is usually due to increased ICP rather than a true localizing sign. Monocular loss of vision can occur with ophthalmic artery aneurysms.
- Hemiparesis: With or without aphasia, hemiparesis is due to middle cerebral artery (MCA) aneurysm, ischemia or hypoperfusion in the vascular territory, or intracerebral clot.
- Leg monoparesis or paraparesis with or without akinetic mutism/abulia points to anterior communicating aneurysm rupture.
- Funduscopic findings include papilledema and subhyaloid retinal hemorrhages.
- Intracranial Hemorrhage
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- Focal neurological deficits
- Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, aphasia, neglect, or apraxia
- Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, miosis, aphasia, or confusion
- Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, abulia, aphasia, neglect, or apraxia
- Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion
- Brain stem - Quadriparesis, facial weakness, decreased level of consciousness, gaze paresis, ocular bobbing, miosis, or autonomic instability
- Cerebellum - Ataxia, usually beginning in the trunk, ipsilateral facial weakness, ipsilateral sensory loss, gaze paresis, skew deviation, miosis, or decreased level of consciousness
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| msyamp
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so the answer is putamen
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| study_ing
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thanx ..god bless u
so i guess headache, nausea, vomiting etc is common to both..
contralateral conjugate paralysis wud help point towards putamenal hemorrhage
and i guess meningismus wud be more common in SAH
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