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Tuesday, January 29, 2013

Hypertension: The Silent Killer

A 70 yr old male patient presented with complaints of sudden onset giddiness, headache, vomiting and right sided weakness of the body since 2 hrs. He was a known hypertensive and had underlying coronary artery disease for which he was on regular medications (except anti platelet drugs). However, he failed to monitor his blood pressure. On examination, his BP was 240/120 mm Hg, pupils bilaterally constricted and reacting to light. He was in a delirious state, though he could obey commands and recognize relatives. His power was 3/5 in right upper and lower limbs.
His CT Brain was done.

It showed a basal ganglia bleed with intraventricular extension with a minimal mass effect. 

The patient was managed conservatively and watched for any neuro deterioration. After 6 hrs, he started becoming progressively drowsy. Pupils were still reacting. The power on right side was markedly reduced now.
A repeat scan was advised.

The bleed had increased markedly with significant mass effect.

A craniotomy was performed with a guarded prognosis with an aim to decompress.
After 12 hrs of neurosurgical intervention, patient remained deeply comatose. A CT scan was performed.


Reduction in the bleed. However a fresh large PCA territory infarct noted.
    

The patient till today remains comatose and on ventilatory support system. Prognosis is very poor.
Relatives and doctors alike are just waiting for the inevitable.

7 comments:

  1. How regularly should hypertensives on medication check their bp? Are electronic bp monitors reliable for checking bp at home? A very gud case presentation article. ����

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  2. Ideally hypertensives should self monitor their pressure once or twice a week preferably at different times. They should consult their physician once in a month. The electronic meters are relatively reliable provided they measure the brachial pressure i.e the arm ones.

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  3. Unfortunately in our country patients don't realise the importance of keeping a regular follow up with their doctor.many a times they stop the medicines on their own or continue taking the same medicine for yrs.

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