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61 yr male presented to my ER with h/o syncope and eye rolling..(30 mins back) No h/o headache ,, No h/o Vommiting. -no significant past medical history except tobbaco chewing and smiking. -BP 104/61mmhg HR 58/min spo2 94% on air O/E - GCS E4M6V5 left UL 4/5 Left LL 4/5 Right UL and LL 5/5 -Anxious look,,chest heaviness + -B/l plantar WNL rest systemic examination grossly NAD. kindly give ur valuable opinion.

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Brain DSA was done which showed right MCA stenosis with left PCA complete stenosis.. 2DEcho was WNL. Except DD II. Patient is stable now. Thank u all.

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An old infarct with encephalomalacia involving parietooccipotal area. ECG shows bradycardia with T inversion limb lead 2 and 3 and chest lead 6 , probably old ischaemic changes. Syncope is due to TIA associated with cerebral atrophy and brain changes . As GCS is normal no specific treatment is required. Tab Rosuvastatin 10 mg + aspirin 75 mg can be started . Tab piracetam + citicholine for 1 month. Get an Echocardiography done and a MRI brain for further evaluation. Also get a Trop - T chest to rule out atypical M.I Stop smoking.

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A case of TIA with Lt sided weakness with inferior wall ischaemia CT scan of brain shows Lt parieto-occipital encephalomalacia with deffuse cortical atrophy EEG as rolling of eyes may be interictial state of seizure disorder Lipid profile Tab Citilec P 500mg BD Tab Livetiracrtum 500mg BD Tab Sorbitret 5mg sos Tab Ecosprin AV(75+20mg) HS Antioxidant 2D echo, Cardiac enzymes Keep under observation

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ECG Sinus bradycardia, HR 50 per minute LAD, LAHB as in L3 AVF, OLD IWMI Bradycardia related postural hypotension .Possible TIA in the MCA territory . Needs follow up .Both CARDIAC and cerebrovascular work up

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Old CVA left parietoocippital region with gliosis. ECG - Bradycardia with T wave inversion.check electrolytes abnormalities. Most probably vasovagal syncope ABG,CBC,Thyroid profile,2d ECHO,MRI Brain

Old left mac territory infarct with gliosis New rt mca territory infarct periventricular , insular cortex Also history s/o seizure more favour cortical embolic stroke In view of significant low bp with bradycardia at the same time LVH in ecg high possibility of ICMP As b/l mca territory involved more likely possibility of cardioembolic stroke Need 2d echo and holter Definite treatment will be anticoagulant Conventional Vs NOAC per patient preference Vascular imaging to rule out simultaneous atherosclerosis as age and smoking history increased risk for it also

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Hypodense area in lt parieticerebellum area suggestive of infarct Ecg grossly bradycardia suggetive of chb Tia treat as stroke Keep ventilation and spo2 Inj dexamethasone Inj clexan Diuretics Rest as required

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Brain DSA was done which showed right MCA stenosis with left PCA complete stenosis.. 2DEcho was WNL. Except DD II. Patient is stable now. Thank u all.

Old infarct with encephalomalacia involving pariato occipital area. ECG shows Bradycardia.

Ecg S.BRADYCARDIA LAHB LVH with strain Old IWMI C.T Hyperdense leasion in Rt Temporopariteal lobe

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