Suggest Treatment For Persistent Headache With Hemorrhage

Dear Doc.
I am Mrs Saroda Sarkar from kolkata. This is a case status of my beloved husbend Mr. Robin kr. Sarkar.

Mr. Rabin Kumar Sarkar, 50 years old hypertensive gentleman was admitted in Peerless Hospital (NNC Kolkata) on 17/ 02/ 2011. He presented with complaints of sudden onset headache with restlessness and vomiting since the morning of the day of admission. A CT scan of brain showed right occipital intracerebral hemorrhage.

On examination, he was conscious with GCS of 15/15 ( E4 M6 V5 ). Pupils were bilaterally 2.5 mm in size and reacting to light. Extraocular movements were of full range. He was moving all four limbs. BP - 130/90 mm Hg, Pulse - 72/min.

Considering the nature and site of his bleed, a DSA was done on 17/ 02/11, which showed a large arterio-venous malformation with feeders supplying from right Anterior cerebral artery ( A2, A3 and A4 segments ), right Middle cerebral artery ( M3 and M4 segments ) and P2 segment of right posterior cerebral artery. The AVM was seen draining into the distal third of the superior sagittal sinus, the deep venous system including the Vein of Galen and straight sinus. There was a large pre-nidal aneurysm identified arising from the right A2 segment.

As the patient was neurologically doing well, conservative treatment treatment with anti-epileptics, cerebral dehydrants, anti-emetics, analgesics and proton pump inhibitors were continued and he was kept under close neuro-observation.

At present, the patient is afebrile, continent and accepting orally well. His headache is persisting.

PLAN :

To proceed for definitive management once the acute episode subsides.