Department of Neurosurgery

Mortality presentation
Presentation and History

 A 60 year old male was

brought to emergency on
17th feb,2023 at 4.18 am in
unconscious state for 2hrs.

.
Examination

 On examination the GCS on arrival was E1

V1 M2
 Patient was intubated in emergency in view
of low gcs
 The pupils were right 4 mm reactive to light

 Left 3mm reactive to light

 The blood pressure was 236/122 mm Hg,
the other vitals were stable.
ASSOCIATED COMORBIDITIES

 Patient was k/c/o hypertension since 2

years on irregular treatment
 Patient was k/c/o chronic kidney disease
since 2 years on irregular treatment
 h/o CVA 3 years back and was currently on
 1) isosorbide dinitrate + hydralazine
 2)tab nicardia
 3)tab bisoprolol
Investigations
 NCCT head was suggestive of Right basal
ganglia hemorrhage with intraventricular
extension with significant midline shift.
 urgent ct angio brain was done which was
of normal
Plan of action

 Medicine reference was taken for high

blood pressure and advice followed
 Patient was shifted to neuro ot for
emergency decompressive craniactomy
with evacuation of haematoma after
councilling attendents and explaing risks
and prognosis
 intraoperatively dura was tense and brain
was non pulsatile
Course during hospital stay

 17/2/23 (pod -0)

Post operatively patient was kept sedated and
paralysed
cardiology and nephrology references were done
Blood pressure continued to be high despite labetalol
infusion
urine output was normal
Oxygen saturation was maintaing on ventilator on
SIMV mode
Poor prognosis is explained to relatives.
 Patient had acute cardio respiratory arrest
on 17/2/23
 CPR was done, despite the best efforts the
patient could not be revived and was
declared dead on 17th feb 2023 at 5.46 pm.
 Cause of Death
 The cause of death is presumed to be large right
basal ganglia bleed with significant midline
shift. With CKD with accelerated HTN
Investigation
Investigation Values (17/2/23)

HB 13.5
TLC 15.37
PLT 403
Urea 74

S. creat 2.47

PT 12.6
INR 0.93
Na 136.8
K 3.8
Cl 110.1
Parameter
Investigation 17/2/23

PR Min:72
Max:86

RR Min:15
Max:15

Temp Min:98.1
Max:99.2

BP Min:-
Max234/130

SPO2 Min:-
Max:100

GCS Min:E1VTMI
Max:E1VTMI
Thank you