Head trauma is the most commone epidural and subdural hematoma, with the majority of cases

related to motor vehicle accidents, falls, and assaults. The linear translation of acceleration
along the diameter of the skull in the lateral direction can produce injury to veins, arteries,
meninges, or brain parenchyma, resulting in multiple forms of intracranial hemorrhage. .
Patients have different presentations depending upon the area of brain that is affected. Some of
the symptoms like hemiparesis, speech impairement, executive dysfunction, sensory
impairment, headache vomiting vomiting, dysphagia, nuchal rigidity, seizure, light headedness.
If it is severe it may result in coma and then death.Risk factors like cerebral atrophy which is
more common in chronic alcohol abuse, older adults and previous traumatic brain injury

Trauma to the head can result in many sudden onset signs & symptoms of central nervous system like
those of this patient’s. with fluctuating headache, confusion, seizure, personality changes etc. There may
be lucid interval ( weeks, months or more than a year ) between the injury and onset of symptoms, Sn &
Sx of ↑ ICP ( headache, vomiting) This is due to either the direct penetrating injury to the head or
secondary to hematoma formation which results in signs and symptoms related to compression to the
brain or still secondary to secondary brain injury following primary brain injury. Despite all these facts
this patient did not have any history of trauma to the head.

IS

A stroke, or cerebrovascular accident, is defined as an abrupt onset of a neurologic deficit that is

attributable to a focal vascular cause which include Ischemic stroke, Hemorrhagic stroke, and Cerebro-
vascular anomalies such as intracranial aneurysms and AVMs (Arteriovenous malformations). All of
which manifest with an abrupt onset of neurologic features that are often focal in nature: Often follow
vascular distributions. Focal ischemia or infarction is usually caused by thrombosis of the cerebral
vessels themselves or by emboli from a proximal arterial source or the heart. A generalized reduction in
cerebral blood flow due to systemic hypotension (e.g., cardiac arrhythmia, MI or hemorrhagic shock)
produces Syncope. If low cerebral blood flow persists for a longer duration, then infarction in the border
zones between the major cerebral artery distributions may develop: Watershed ischemia Intracranial
hemorrhage (ICH) is caused by bleeding directly into or around the brain; it produces neurologic deficit
by mass effect, blood toxic effect or increased ICP. Generally it has modifiable and non modifiable risk
factors.
It ahs complications like infectionaspiration from loc, pressure sore, venous te like dvt pe, constipation
all of these due to immobility : cerebral edme and hemorrahge, seizure due to cortical brain brain
injury : fall down injury during attack are among early cxn. Late complications like spascity, Neurologic
disability or paralysis like wheelchair dependent, Epilepsy, Aphasia, Sleep disturbance, Socioeconomic
factor related to difficulty in involvement of daily activity and permanent need of help from family
members, Depression/anxiety from prolonged immobility and others.

Patients presentation ( maximal in onset and notices while he is waking up from his bed ) which are
typical for ischemic stroke. And the patient has also risk factors like male sex, dm, htn. And on physical
findings he has also right sided hemiparesis with facial palsy and signs of upper motor lesion support this
diagnosis. Therefore this os the most likely diagnosis.

Final assessment: right sided, crossed, spastic hemiparesis 2 t IS 2 to htn, dm

variety of conditions in which blood flow to part or all of the brain is reduced, resulting in tissue
damage.

Acute occlusion of an intracranial vessel causes reduction in blood flow to the brain region it supplies
because of either an in-situ thrombosis formation or an embolus showered from the heart or proximal
arteries. The occulusion is due to emboli (cardiac or arterio arterial emboli) or thrombosis. It accounts
aroung around 80% of stroke world wwide.

Ischemic strokes are due to a reduction or complete blockage of blood flow [2]. This reduction
can be due to decreased systemic perfusion, severe stenosis, or occlusion of a blood vessel.
Decreased systemic perfusion can be the result of low blood pressure, heart failure, or loss of
blood. Determination of the type of stroke can influence treatment to be used. The main causes
of ischemia are thrombosis, embolization, and lacunar infarction from small vessel disease.
Ischemic strokes represent approximately 80 percent of all strokes.

It is a sudden onset of focal neurological deficit due to occlusion of a major artery leading to decreased
blood flow to the brain resulting in cerebral infarction. Accounts for about 85% of all stroke in developed
countries. Occlusion may be due to Thrombosis or embolism; which could be caused by atherosclerosis,
blood disorders (polycythemia, thrombocytosis), vasculitis, atrial fibrillation, myocardial infarction,
cardiomyopathies, infective endocarditis…
The risk factors are similar with that of hemorrhagic stroke. The major physical findings which are
hemiparesis, Right sided facial nerve palsy. The way of presentation (sudden when awakening from bed
with no warning sign and maximal at onset)

Hemorrhagic Stroke

It is a sudden onset of focal neurological deficit due to primary intracerebral hemorrhage or

subarachnoid hemorrhage.Accounts for about 15-20% of all stroke world wide. Mostly it has gradual in
onset and happens while the patient is awake and doing his/ her daily activities ulike ischemic otherwise
otherwise it has almost similar clinical feature and risk factors. Iit is caused by hypertension, vascular
malformation, intracranial tumor bleeding disorders, anticoagulants, cerebral amyloid angiopathy,
vasculitis, and the like. Of the many risk factors, those that fit our patient’s findings are: male gender,
hypertension. Diabetes mellitus. Putamen and thalamic hemorrhage could explain some of the physical
findings (contralateral hemiplegia, sagging of one side of the face). But the htn is controlled and short
duration plus the patients presentation (noticed the weakenss early in the morning when he tries to
wake up) makes less likely diagnosis.