Author/Authors :
Santos, Vitorino M. Catholic University (UCB) - Armed Forces Hospital (HFA) - Internal Medicine, Brazil , Santos, Fabio H. B. Armed Forces Hospital (HFA) - Internal Medicine, Brazil , Leal, Cristina T. Armed Forces Hospital (HFA) - Internal Medicine, Brazil , Prates, Amanda D. Armed Forces Hospital (HFA) - Internal Medicine, Brazil , Cruz, Leonardo R. Armed Forces Hospital (HFA) - Internal Medicine, Brazil
Abstract :
A 93-year-old woman who suffered arterial hypertension for 20 years, and had been irregularly treated, presented with abrupt headache, nausea/vomiting, confusion and disorientation, followed by left hemiplegia and right facial palsy. Remarkable findings on admission were: blood pressure 220 x 120 mmHg; Glasgow coma scale (GCS) score 13; paralytic dysarthria; left hemiplegia with hypotonia and hypoesthesia; brisk deep tendon reflexes with upgoing plantar response on the left side; right lower facial palsy and conjugated gaze deviation to the right. About six hours after the initial symptoms, a noncontrasted computed tomography of cranium (Figure 1) showed right thalamicinsular (4.9 x 3.4 x 2.5 cm) hypo dense area (arrowheads), and liquid-liquid levels in less than half the volume of the posterior horns of lateral ventricles (arrows). The sequence of the laboratory data are shown in Table I. Because of the old age and the general clinical condition, she was managed conservatively, and received intensive care support for 47 days.
