Concluded Case

infarct or ICSOL??

89/f was brought to emergency with c/o sudden onset A/s since 5 am on 2/6.there was no h/o seizure, headache, vomiting,head injury.no h/o chest pain.pt is k/c/o of asthma since 5 yrs.plantar Rt extensor lt flexor.kindly comment on diagnosis and treatment.

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Concluded answer

Ischemic infarction left MCA

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Large size hypoechoic shadow lt parietal and cerebellar area compressing lt ventricles Xray chest shows cardiomegaly Rt cardiac border is more prominent and shifted to rt Prominent pulmonary artery on rt side Ecg show sinus tachycardia Mild t inversions marked in circles with low amplitude R consistent with pericardial effusion Findings are suggestive of CVA Acute stroke as likely infarct with perilesional effusion in parietal area Old age pt k/c of asthma suggest hypoxic cerebral lesions Planter rt extensor supports lesion on lt side likely infarct Rx inj NS Inj dexamethasone 8hrly Inj Ceftriaxozone Inj lasix Inj clexan Inj deriphyllin Rest supportive treatment with detail investigations

Thanx dr Pushkar ji Bhomia
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Left hypodensity seen involving left MCA territory with effacement of cortical sulci,edema,shifting of midline to contralateral side and subfalcine brain herniation.In keeping with ischaemic infarction of left MCA territory. Cause include - Cardioembolic,hypercoagulable states, Antiphosholipid syndrome,SLE.Urgent Neurosurgery opinion for Decompressive craniectomy to release pressure,Take a high risk consent for surgery more than risk of death if not surgery. RT insertion- RT feed every 6hrly,CVP line, Tracheostomy.Osmotherapy with mannitol or hypertonic salt,AEDs,Dual anti platelet therapy, Diuretics,Antipyretics,Cerebral dehydrant,Dexa.IV fluids along with supportive care,Chest and limb physiotherapy.

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? CEREBRAL ATROPHY .. WITH .. CARDIOMEGALY .. WIDE HILAR SHADOW .. NEED'S.. CLINICOPATHOLOGICAL EVALUATION WITH .. HOSPITALIZATION IN HIGHER CENTERS..

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diffuse cerebral Atrophy Lungs right lung collapse consolidation B/L Pneumonitis ? COVID infection Ad HRCT thorax RT PCR for COVID

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Ischemic infarction left MCA

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Lt parietal large infarction with rt hemiplegia Chest X-ray ecg ? Dextrocardia?

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Hypothorax plural effusion Pneumonia Emphysema

Cerebral atrophy, pneumonitis, pleural effusion, Cardiomegaly, CCF. Rt-PCR,ECG, cardiac profile..

Cerebral atrophy, increased cranial pressure, Lt MCA territory infarction, cardiomegaly+ , ? B/L pneumonia Management as for CVA, Pneumonia with Asthma...

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Cardiomegaly, prominent hilar shadows. Encysted pneumothorax rt.upper zone.

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