Cva Left hemiparesis. 35 yr old female. not hypertensive not diabetic. is it young stroke? Right Middle cerebral artery infarct?

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Antiplatelet therapy has been shown to reduce the risk of numerous vascular events, especially in the setting of secondary prevention. DAPT with aspirin and another antiplatelet agent such as clopidogrel, prasugrel, or ticagrelor has become the main stay of acute coronary syndrome (ACS) management. The underlying pathophysiologies of ACS, ischemic stroke, and transient ischemic attack (TIA) are similar. In the setting of ACS, DAPT has clearly been shown to improve outcomes over single antiplatelet therapy for up to 12 months after the ischemic event. However, the role for DAPT in the setting of ischemic stroke and TIA is less clear. The MATCH, CHARISMA, and SPS3 studies demonstrated that DAPT was associated with increased bleeding compared with single antiplatelet therapy without an appreciable reduction in ischemic events. Early initiation of DAPT proved beneficial in reducing future ischemic events in the FASTER and CHANCE trials; however, these trials did not provide enough evidence to recommend the routine use of DAPT in secondary stroke prevention, and current guidelines recommend against such therapy. DAPT with aspirin and clopidogrel appears to be effective only for patients with minor stroke or TIA when started within 24 hours of the ischemic event and continued for a maximum of 21 days .At present, there is no data to suggest that prolonged use of DAPT beyond 3 months is better. But some RCT's and meta-analyses suggest that short-term use of dual antiplatelet treatment initiated early after ischemic stroke and TIA reduces the risk of recurrent stroke and major vascular events without significantly increasing the hemorrhagic complication rates, particularly in those with large-vessel disease, while long-term dual antiplatelet treatment increases the risk of systemic and intracranial hemorrhage over time, offsetting any potential benefit. Loading dose of Aspirin is 300mg and Clopidogrel is 75mg in Acute Ischemic Stroke and TIA. No other newer Anti-platelet is approved by FDA for Ischemic Stroke.

sir,excellent explanation thank you
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young CVA is very intresting condition . as u said no htn &dm. then try to find out cause as window period must be over , no need to discussed on thrombolysis... but we can thing on secondary prevention , for now jus Ecosprine 150 mg is enough.. get 2decho done for cardiac source of embolus, and Doppler to intrnal carotid. do fasting lipid profile , search for hypercoagulable conditions very common in female like apla, protein s deficiency , ect mannitol can be given if get any signs of raised intra cranial tension . most important part of physiotherapy to paralysed part of body.

Rt.mca territory stroke - it's young stroke premorbidily healthy. ct scan shows subtle hypodensity seen on rt .post limb of internal capsule basal ganglia ,corona radiata ,caudate nucleus patchy infarct. management - 1) needs close neuro observations 2)keep slightly blood pressure on higher site than normal to increase cerebral perfusion. antiplatelet and statin we have to do stroke protocol mri brain to look for blood vessels r/o? extracranial stenosis ? dissection and size of infarct. if clinical and neurological worsening repeat mri brain screening means limited study needed if mid line shift >8 -10 may need decompressive craniectomy as a life saving measure.

No need to give osmotic agents like mannitol,as there is no increased intrcranial pressure,blood volume,or edema,use citicoline/piracetem,LWMH/ecosprin. find out source and cause of infarct.

if pt is conscious not required. but young stroke full evaluation require. MRI brain Stoke protocol. serum homocysteine level. lipid profile ana profile ECG echo carotid Doppler. start ecosprin bd statin 80 mg citacoline bd lmwh bd multivitamin. Neurophysician opinion. if pt come in4 hours of stroke and not and contraindications do thrombolysis. Physiotheraphy

is nootropil required sir iv tds
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It is a case of young stroke. Needs all work up for young stroke.Check is she on oral contraceptive pills or not.Vasculitis screening including fasting homocysteine level. Cardiac evaluation.

It's acute infarct involving posterior limb of right internal capsule , corona radiate and centrum semi ovals

Tab Disprin od.Tab citicholine.Tab steroids & cap pantaprazole refer to higher centers for further management but Conservative treatment with antihypertensive & anticoagulant preferred drugs of choice.

sir why citicholine n steroid ? kindly explain.
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Acute cerebral infarction, reduce cerebral oedema.

Cerebral infarction right.

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