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Clinical Progression TOPIC

Cranial CT

Day 3 no change in size                                                                            Day 10 decrease in size of hematoma

                   

Day 30 resolution of hematoma

 

→ Medical decompression with Hypertonic saline was done with improvement in sensorium from Glasgow Coma Scale (GCS) 8 to GCS 11.

 

Q: Is hypertonic saline better than mannitol in reducing increased intracranial pressure?

Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: A meta-analysis of randomized clinical trials (Kamel et al. 2011. Critical Care Medicine. 39(3):554-559)

 

Q: What are the causes of secondary hypertension?

Common causes
Renal parenchymal disease
Renovascular disease
Primary aldosteronism
Obstructive sleep apnea
Drug or alcohol induced
Uncommon causes
Pheochromocytoma/paraganglioma
Cushing’s syndrome
Hypothyroidism
Hyperthyroidism
Aortic coarctation (undiagnosed or repaired)
Primary hyperparathyroidism
Congenital adrenal hyperplasia
Mineralocorticoid excess syndromes other than primary aldosteronism
Acromegaly

→ CT scan of abdomen and CT aortogram

Figure 5: CT scan: Bilaterally enlarged kidneys with multiple diffusely scattered cortical cysts (left); CT aortogram: thoracoabdominal aortic dissection (right)