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X-ray Case (3)

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Diagnostic:
35 year old woman from Africa presented with projectile vomiting preceded with headache.

Nothing important in past medical history apart from chronic cough.

Investigation: look at the attached Image

Questions
1- What is your diagnosis?
2- What other important clinical presentation?
3- How to treat this patient?
Diagnostic

Muna1:
happy new year for all inshall ah   :).
i think the diagnosis is Subarachnoid Hemorrhage
clinically presentation :
acute onset of sever headache , nausea, vomiting,an altered level of consciousness , nick stiffness
 management of the patient :
1 admission in ICU
2 The head end of the bed should be kept elevated at 30°
3 Relief of associated vasospasm medically with calcium channel blockers
4   Urgent surgical removal of blood may be indicated and maintenance of cerebral perfusion
5   Early surgical clipping is used to prevent re bleeding
6   Control blood pressure , prevention of seizures, treatment of nausea, management of ICP,  control of pain.
 i hope it is correct.
.

Diagnostic:
It's one of the differential diagnosis but try again!

Mustafa:
assalam aleikum dear poster,

The clinical symptoms seem to be suggestive for an elavated intracranial pressure complicated by multiple brain lesions/metastasis. undermentioned an attempt for an explanation:
1. Headache ( 40 to 50 percent ) is a common manifestation of brain tumors and is the worst symptom in about one-half of patients. The headaches are usually dull and constant, but occasionally throbbing.
2. Brain tumors can cause nausea and/or vomiting by increasing the ICP at the area postrema of the medulla  ( the area in the floor of the fourth ventricle which contains a "chemoreceptor trigger zone" that is sensitive to many humoral factors, including neurotransmitters, peptides, drugs, and toxins. ).
Patients with primary or metastatic brain tumors may present with either generalized ( Headaches, seizure, nausea/vomiting, depressed level of consciousness and neurocognitive dysfunction ) or focal ( seizures, weakness, sensory loss, aphasia and visual spatial dysfunction).
treatment:
The management of patients with multiple brain metastases remains a difficult challenge for neurosurgeons. The KPS ( karnofsky Performance Scale ) score has been used as a major predictor of survival in patients with multiple brain metastases. It is generally accepted that patients with a KPS score of 70 or greater may benefit from either resection and/or radiosurgery, it has been shown that patients with higher KPS scores experienced prolonged survival compared with those with a score lower than 70. This patient has a poor prognosis when compared with those harboring a solitary brain metastasis, and historically treatment has generally consisted of administering whole-brain radiotherapy once the diagnosis of multiple brain metastases is made.
Besides,whole-brain radiation therapy is the standard therapy for brain metastasis, with an established body of literature supporting its use for multiple metastases. Moreover whole-brain irradiation has the ability to eradicate micrometastatic disease to delay recurrenceand is often used in conjunction with surgical resection or radiosurgery. It is tolerated fairly well and can be very effective for radiosensitive tumors such as metastases from small cell lung cancer.


wa assalam caleikum
Mustafa

Diagnostic:
Dear Mustafa, you are so close
There is elevated intra cranial pressure with multiple brain lesions but it's not due to metastasis.
Try again
Diagnostic

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