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Focal Weakness 

Focal Weakness
Focal Weakness
Acute Care Casebook

Jordan Tozer


The case illustrates how to approach the management of intracranial hemorrhage related to severe hypertension. Early recognition is the key initial step, which will mediate downstream management and help distinguish this entity from mimics such as ischemic cerebrovascular accident, encephalopathy, and hypoglycemia. Management of intracranial hypertensive hemorrhage is predicated upon tight blood pressure control, reducing intracranial pressure, and possible neurosurgical intervention. Prognosis is uniformly poor, even when recognized early. Key management issues include the consideration of hypoglycemia in the differential diagnosis, obtaining an emergent noncontrast head computer tomography scan in a patient with stroke-like symptoms, and rapid blood pressure management.

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