A hyponatremic hypertensive emergency..
Dr. Sumit Giri
A hyponatremic hypertensive emergency..
A 43 year old man currently in icu with coma..he had presented with h/o hypertension( 1 reading on 200/120) and on the day of presentation had headache , vomiting with seizure immediately after admission followed by coma with fixed and dilated pupil and respiratory failure(pao2<60,spo2<50) required immediate ventilation...CT head done suggstive of diffuse cerebral oedema...provisional diagnosis was brainstem stroke..The next day review brainstem reflex present (pupil, dolls eye,occulocephalic reflex present)..plan made to wean off sedation and evaluate neurological recovery with time and mannitol and ventilation to continue..
lab diagnosis_: na+_ 104meq/l..k+_4.2meq/l..
Two days treatment hyponatremia is controlled on slow 3% correction over the last 2 day and na+ 124 he is still comatose with comatose with intact brainstem reflex..

que_ what is the role of cranial MRI is detecting brainstem infract in scenario?? what eeg helps in throwing further light?? what is further approach??
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