QUESTIONS AND TEXT
Q1 What is your diagnosis for this CT and MRI images?
Q2 What is your plan of management?
A 48-year-old Asian male with history of ischemic cardiomyopathy with
low Ejection fraction (EF 15%). Received thrombolysis 2 months ago due
to Right middle cerebral artery stroke. Presented with low cardiac
output state require vasopressors support. Follow up CT brain after 2
month of thrombolysis show (Fig 1-2) multiple hypodense areas with
Haemorrhagic transformation and mass effect, MRI confirm gliosis with
secondry haemorrhagic transformation and mass effect (Fig 3-4).
Neurosurgeon Decision based on only reviewing CT and MRI images was for
urgent dehydrating measures and to be refered to the neurosurgery centre
for decompressive craniotomy. Surprising the patient was fully concious,
alert and oriented with left haemiplegia. Even with no dehydrating
measures patient remain stable with same concious level.