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.