Concluded Case

A PATIENT WITH ACUTELY DECREASED VISION AND lEFT SIDED NUMBNESS.

57yrs/M known Asthmatic patient presented to ED with decreased alertness and responsiveness since 5 hours, which has resolved on presentation.Now Complaints of Decreased vision and numbness of the left side of the body.H/o CVA 1yrs back as stated by Patient son.MRI LS spine shows Spondolysis with Osteoporotic changes with collapse D12,LVEF - 45% on Blood thinners.Tested NEGATIVE FOR COVID 19.KINDLY DISCUSS THE CASE? Vitals BP - 130/80,PR -75,Spo2 -98,Temp -100°F Physical Examination Babinski's upgoing bilaterally.DTRs 2+ throughout biceps

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Dr Prashant ,you want to discuss the case. 57 yr yr ,M,I hope sudden onset of alteration in sensorium with complete recovery after 5 yrs. Back ground history of stroke,the most probable diagnosis is TIA posterior circulation.Asthmatic pt,asthma related hypoxemia is unlikely to recover quickly, it will take time and very slow recovery. Here you have to mention what is the interval of recovery and the new symptoms like blurring of vision and numbness. Blurring of vision and numbness can occur in parietal lobe ,thalamus in a posterior circulation stroke. Incomplete basilar stroke also can produce the same symptoms. Blurring of vision can issue in occipital lobe lesion but pure occipital lobe lesion Is unlikely to produce numbness unless it is associated with parietal lobe involvement / thalamus involvement.In view of the left sided numbness, the lesion must be in the rt PCA or incomplete basilar artery involvement. So clinically this pt has posterior circulation TIA followed by postetiorcirculation stroke. Clinical discussion With MRI correlation.Acute infarction Rt PCA and old infarction left PCA. Small lacune left pons,multiple small periventricular T2 hyperintense lesion left more than rt suggestive of CSVD. Final diagnosis Basilar artery stroke, with MRI features of CSVD. Management : Dual antiplatelets,statin ,neuroprotective,Cardiac evaluation,physio with gait training. Gabapentin small dose if numbness persisting left side. Give feedbacks.

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Dr Prashant ,you want to discuss the case. 57 yr yr ,M,I hope sudden onset of alteration in sensorium with complete recovery after 5 yrs. Back ground history of stroke,the most probable diagnosis is TIA posterior circulation.Asthmatic pt,asthma related hypoxemia is unlikely to recover quickly, it will take time and very slow recovery. Here you have to mention what is the interval of recovery and the new symptoms like blurring of vision and numbness. Blurring of vision and numbness can occur in parietal lobe ,thalamus in a posterior circulation stroke. Incomplete basilar stroke also can produce the same symptoms. Blurring of vision can issue in occipital lobe lesion but pure occipital lobe lesion Is unlikely to produce numbness unless it is associated with parietal lobe involvement / thalamus involvement.In view of the left sided numbness, the lesion must be in the rt PCA or incomplete basilar artery involvement. So clinically this pt has posterior circulation TIA followed by postetiorcirculation stroke. Clinical discussion With MRI correlation.Acute infarction Rt PCA and old infarction left PCA. Small lacune left pons,multiple small periventricular T2 hyperintense lesion left more than rt suggestive of CSVD. Final diagnosis Basilar artery stroke, with MRI features of CSVD. Management : Dual antiplatelets,statin ,neuroprotective,Cardiac evaluation,physio with gait training. Gabapentin small dose if numbness persisting left side. Give feedbacks.

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Recurrent cva , rt pca infarct with gliotic area left occipital , avoid asprin in copd pt , give clopidogrel , rosuvas , dabiclot can be given , do all other work up , serum homocysteine, do angiography brain, echo , bilateral carotid dopler , supportivev treatment , lmwh

Sir thanks for ur valuable opinion,what to do for decreased vision?
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Recurrence of CVA.... was it a hemorrhagic CVA or infarct...was the pt on ecosprin?

Left pca territory old stroke f/b gliosis A new ischaemic stroke in rt pca territory.. Evaluate for pca circulation by vessel imaging Start DAPT with statin Poor prognosis for vision as b/l pca now gone

Lacunar infarct in basal ganglia Cerebral bleed in rt occipital region extends to rt thalamic Ref to neurosurgeon

Old left PCA infarct with collapse vertebra with cord compression

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