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
Cushing’s syndrome
Aortic coarctation (undiagnosed or repaired)
Primary hyperparathyroidism
Congenital adrenal hyperplasia
Mineralocorticoid excess syndromes other than primary aldosteronism

→ 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)