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What is not?

 Impossible is not a fact, its an opinion 

Stroke-Cerebrovascular disease

May 16, 2010 by drsalman

Case Sheet

A 40 year old male brought into office by his wife who noticed him having a weakness of his right arm and face during his lunch.Weakness soon disappeared within 15 minutes and pateint recovered completely.During episode pateint denies any other complaint apart from weakness which he noticed.Patient is now back to normal and deny hallucinations,delusions,illusions, any headache ,weakness,tingling,confusion,memory loss,chest pain,palpitations,sweating,blurring of vision,abnormal movements,Diplopia,abnormal taste sensation,difficulty in hearing,abnormal gait,Difficulties in swallowing,or loss of smell sensation.His maternal aunt has history of epilepsy and his father is suffering from CAD,HTN.Patient never had similar complaints in past.Patient is a chronic smoker,Chronic alcoholic and works as school van driver.Pateint has a history of Hypertension and paroxysmal Afib.

On examination:No pallor,icterus,cyanosis,clubbing,pedal edema

BP:130/90 mm Hg

PR:82/Min Irregular

Temp:98.6F

RR:16/min

        Carotid bruits audible on left side.

Pateint is right handed  and Neurological examination within normal limits.

 

Case Discussion: 

Embolic Stroke:Young age,acute onset,during day,cardiac leison present,rapid recovery

Thrombotic stroke:Middle or old age,Insidous onset,Occurs during sleep,gradual recovery.

Hemorrhagic stroke:Middle or old age,Acute onset,during morning hours,H/o HTN,no or partial recovery

 

Rules: 

Symtoms:

Weakness:60

Headache:40

Nausea/Vomiting:20

Hallucinations,Delusions,Illusions:10

Abnormal olfaction:05

Diplopia:10

Blurring of vsison:10

Difficuly in hearing:10

Difficulty in swallowing:05

Tingling sensation:40

H/O HTN:40

H/O CAD:40

H/O Arrythias:40

H/O DM:35

F/H/O:HTN/DM/CAD/CVD:20

Smooking 20

Alcohol 10.

Carotid brui:10

Irregular pulse:20

Abnormal neurological examination:30

Normal Neurological examination:10

CT showing Hemorrhage then Hemorrhagic stroke

Ct Showing Ischemia then Ischemic stroke

Embolic stroke+/-Thrombotic stroke=Ischemic stroke

If Duration less than 24 hours then TIA

If duration morethan 24 hours and pateint deficit worsening then Evolning stroke

If pateint deficit recovers in 1-3 weeks then Reversible Ischemic neurological defiict

If pateint deficit does not worsens after 96 hours then Completed stroke

If diagnosis TIA then Give Heparin+/-aspirin

If Ischemic stroke :Thrombolysis+/- heparin+ aspirin

If Hemorrhagic stroke:BP Control+avoid aspirin

Give statins in all cases.

In all pateints advice quit smooking,alcohol,monitor BP

 

Questions: 

What is the diagnosis?

What is next best step in management??

How do you differentiate Embolic,Thrombotic,Hemorrhagic stroke??

How will you localise lesion??

What are investigations??

What are indications and contraindications of thrombolysis??

Wwhat are risk fators for thrombotic and Hemorrhagic stroke??

 

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