65 yr old female wid sudden onset loss of speech,headache,confusional state,insomnia,generalised weakness.h/o dm irregular on drugs.b.p 150/80 .bsl random 350.intermittently follows command.kindly suggest further management .ct brain done after 4 days of the onset of symptoms.

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There is an Infarct in inferior division of left MCA,, Start the patient on tab. Ecosprin 150 mg od Tab. Rosuvastatin 40 mg of Tab.strocit plus 1-0-1 Start on Iv fluids ,, normal saline,, as there is HYPERGLYCEMIA ,, so probably patient will have dehydration Get 2d echo,, carotid doopler, CBC, serum electrolytes, urea, creat, urine for ketone bodies U can start on metformin 500 mg 1-0-1 And add sliding scale insulin as per the sugar levels there after,, gradually escalate OHA , based on the response Do not give antihypertensive unless BP is more than 180/90

nicely explained sir.
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left parieto-occipital infarction. Suggested therapy to achieve normoglycemia, Ecosprin150. If features of raised ICP like bradycardia or hypertension Mannitol or hypertonic saline if Sodium level is at lower margin

thank u sir.
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its infarct in inferior division of left MCA,, start iv normal saline due to diabetes so suggestive treatment to achieve normal level of sugar give inj heparin inj strocit tab rosuvastin 40.if hypertension mannitol give nd investigation cbc,electrolyte,urea,creat,urine for ketone bodies

inj heparin doesn't come in guidelines studies say it cause more harm than benefit
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Ct shows recent infarction left parietal,LT MCA pisterior division infarction. Good control of DM,antiplatelets,start with ischemic infarction protocol

Left MCA infarct - evolved Start on s/c enoxaparin 35 mg OD Aspirin + clopidogrel 75 mg OD Atorvastatin 20 mg HS Control BP with amlodipine 5mg OD then titrate Control RBS - check rbs Q4H, start on human mixtard 10-0-10 ,then titrate You can give actrapid according to rbs in addition to mixtard Later Change to OHA @the time of discharge IV fluids - RL/NS Rules tube ,catheterization Chest and limb physiotherapy Speech therapy Watch for pupillary assymmetry ,elevated bp, gcs deterioration -if present- suspect hemorrhagic transformation of infarct / malignant infarction Then do a left decompressive craniectomy

Ok dr shino .
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l mca infarct aspirin low mol wt heparin piracetam citicholine edaravone anticonvulsant osteragel cerebrolysin nrmoglycemia fluid electrolyte balance echo heart and doppler carotid to rule out arrhythmia etc cardiac cause of infarct

Y heparin n anti convulsant sir??
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Left MCA infarct

Old infarct in watershed territory of left MCA/PCA

1)Pt.is in golden hrs for thrombolysis. 2) Better to do thombolysis if there is no Contraindication

4 days hv passed sir since the onset of symptoms n the presentation of the patient.
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infarct inj lmwh inj nootropil inj mannitol decrease intracranial pressure inj insulin-r acc to sugar and tab clopid 150mg.1 od tab atorva 4mgo hs tab esai 5mg hs tab nifedipine 10 bd glycerol liq and rt follis cath...latter on mri

tab atorva 40mg
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