DrVirgo
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A 71 year old man is brought to the ER with acute onset of headache, vomiting, and confusion. The family reports that he has a long history of poorly controlled hypertension with hypertensive renal disease adn eye disease that were diagnosed 3 years ago. They report that, a few hours ago, he rapidly developed a very severe headache adn over th enext half hour became more lethargic and confused, and had 5 episodes of vomiting. His blood pressure is 235/140 mmHg in both arms and he appears to have a lateral gaze paralysis on the right. There is no nuchal rigidity, and the pupils appear reactive bilaterally; however, papilledema is evident on fundoscopic exam. which of the following is the most likely diagnosis?
A. Cerebellar hemorrhage
B. Epidural hematoma
C. Putamenal hemorrhage
D. Subarachnoid hemorrhage
E. Subdural hematoma
and why?
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| yasmeen
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subarachnoid hemmorhage. severe headach plus htn
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| doc_clotaire
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lateral gaze paralysis on the right = putamen nerve deficits
C. Putamenal hemorrhage
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| DrVirgo
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C.
HTN, hemorrhage -Caudate and putamen is the MC site for bleed (70%) which can lead to Increased ICP.
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| tongsaa
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C
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| dr in trouble
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yes it is C
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| cirus
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Putamen hge --> C
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| young_doc
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C.
Patient has unilateral lateral gaze palsy, due to Putamen hemorrhage, which is the MC site for hypertensive hemorraging.
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| drxyz
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A
cerebellar haemorrhage causes lateral gaze palsy.
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| DrVirgo
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The correct given answer is C and the reason is above.
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| drxyz
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A
cerebellar haemorrhage causes lateral gaze palsy.
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| drxyz
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the qtn didnt mention anything about hemiparesis.
probably cerebellar haemorrhage
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| drxyz
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in putamen haemorrhage eye deviate away from paralysed side.
no hemiparesis in cerebellar haemorrhage.
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| DrVirgo
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This is a Q-book question..I posted it because I got it wrong too... I chose D, but thats not the answer either...
The given answer is as follows:
CHOICE C IS RIGHT BECAUSE ---> This patient is having a hypertensive hemorrhage. The caudate and putamen are the most common sites for such bleeds (70%), which can lead to dangerous elevations in intracranial pressure as in this patient. The signs and symptoms of increased ICP, whcn present, portend imminent herniation of the brain and certain death These patients require urgent intervention to lower their blood pressure.
Choice A is WRONG because ---> The cerebellum is an uncommon site (<5%) for hypertensive hemorrhage. When cerebellar hemorrhages occur, urgent intervention is required because they can cause brainstem compression and/or obstructive hydrocephalus.
Choice D is WRONG because ---> SAH is infrequently associated with severe hypertension and is usually accompanied by meningismus. Once the SAH is identified, neurosurgical intervention to stop the bleeding can be performed, and the patient thereafer has a normal life expectancy. The most common non-traumatic cause for SAH is a berry aneurysm in the anterior portion of the circle of Willis.
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| Justice
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Well, the answer is linked to the strongest association with HTN not to clinical presentation... To me, this is not correct way to explain something...
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