Concluded Case

LATERAL MEDULLARY SYNDROME

62yrs old male known Hypertensive experienced unsteadiness on walking,dizziness,neck pain with left facial numbness 4hours after waking up in the morning.He rapidly become unconscious followed by fits. O/e - Left sided hemiparesis,Plantars - Left extensor,Right - Flexor,Pupils - B/l 7mm NRTL,GCS - E1M3V1,Corneal reflexes were supressed bilaterally,BP - 170/90mmhg,PR -130/mt,Temp - 103°F Neurosurgery opinion were taken and patient is on conservative treatment but fever is not coming down(Tracheal culture send). present status - Patient is conscious following commands, Tracheostmised on RT feed. DIAGNOSIS AND SUGGEST FURTHER MANAGEMENT PLAN?

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Concluded answer
Acute vertebro basilar stroke involving Dorsal part of pons and midbrain, bilateral symmetrical thalamus ( artery of Percheron involved) bilateral cerebellar Rt > Lt) pica territory Additional old gliosis / hyperintensity on flair image Dwi doesn't show medullary Involvement Prognosis - not good Needs airway monitoring with tracheostomy May he became " locked in state" Medical management Antiplatelet + statin Hydration to keep MAP up Physiotherapy and rehabilitation.. Note- many patient present with convulsive like episode in that case we should do mri brain stroke Protocol
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Clinical notes and MRi findings are not going well. NOT LATERAL MEDULLARY SYNROME. Structures involved in MRI brain-- Bilateral medial thalami left more than rt,mid brain pons ,rt cerebellar peduncle with rt cerebellum involvement left middle cerebellar peduncle suggestive of posterior curculation/ incomplete Basilar artery stroke.Old Rt parietal ischemic lesion. Treatment symptomatic antiplatelets,DVT prophylaxis ,statin,rehabilitation care. Cause of fever most probably tracheostomy site infection or aspiration.
There is an acute infarct involving dorsal lateral part of right sided medulla and cerebellar- most likely a thrombus or embolus in PICA or vertebral artery . Also called wallenberg syndrome or lateral medullary syndrome- aim of treatment now is symptomatic treatment, AED's , RT feeding, rehabilitation and treatment of fever of central origin - may be involvement of hypothalamus., the reason of fever not coming to normal. Patient may have problems of dysphagia , dysarthria and gait disturbances
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Hi @Dr. Prashant Ved this cannot be considered as lateral medullary syndrome, there is old rt. Parietal ischemic attack... Suggest to conduct a pt/inr Current treatment involves antiplatelets Start DVT prophylaxis if inr not normal Persistent cause of fever can be trachestomy site or existing infection.
Acute vertebro basilar stroke involving Dorsal part of pons and midbrain, bilateral symmetrical thalamus ( artery of Percheron involved) bilateral cerebellar Rt > Lt) pica territory Additional old gliosis / hyperintensity on flair image Dwi doesn't show medullary Involvement Prognosis - not good Needs airway monitoring with tracheostomy May he became " locked in state" Medical management Antiplatelet + statin Hydration to keep MAP up Physiotherapy and rehabilitation.. Note- many patient present with convulsive like episode in that case we should do mri brain stroke Protocol
@Saumya Mittal sir,@Abhijit V sir,@Manorama Rajan mam,@Dr. Yashesh Dalal sir,@Dr. Gajanan Patil sir,@Parveen Yograj sir,@Hardik Ahuja sir,@Bhupesh Kumar sir,@Padam Chand sir.
Old infarct iRt parietal region
Sir,MRI findings??
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Posterior circulation stroke
Agree with manorama madam
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