Concluded Case

Haemorrhagic transformation of ischaemic infarct

38yrs/M with K/c/o CAD with HTN was on irregular treatment for past 3mnths presented to casualty after 8hrs of onset of weakness of left sided upper and lower limbs along with Mild difficulty in breathing. O/e - Patient drowsy,arousable, localising pain,Pupils - B/l Assymetrical non reactive,Vitals unremarkable,CNS - Left sided hemiplegic, extensor plantar on left side,GCS - E3VAM4-5. KINDLY INTERPRET CT AND MRI BRAIN AND SUGGEST MANAGEMENT PLAN TOO?

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Young acute ischemic stroke out of window period Mechanism of stroke- looks cardioembolic Due to dilated LA/LV EF-10/15% SEVERE MR global hypokinesia sec to neurogenic (taktsubo cardiomyopathy )cerebral edema CT SCAN- RT. Temporo- parietal Hypodensity with sulci gyri Effecement without mass Effect Mri brain showing- Rt. Mca territory large infarct with hemorrhagic transformation without mass Effect His clinical conditions and pupils not reacting is not correlating Treatment- single Antiplatelet+ statin Antiedema measure Head elevation (30°-45°) Bp monitoring- hydration Cardiologist opinion must be taken No LMWH due to already hemorrhagic transformation I THINK DECOMPRESSION Craniectomy ( neurosurgical standby for if needed) We should do close neuromonitoring After Settled his condition - Physiotherapy and aggressive rehabilitation
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Young acute ischemic stroke out of window period Mechanism of stroke- looks cardioembolic Due to dilated LA/LV EF-10/15% SEVERE MR global hypokinesia sec to neurogenic (taktsubo cardiomyopathy )cerebral edema CT SCAN- RT. Temporo- parietal Hypodensity with sulci gyri Effecement without mass Effect Mri brain showing- Rt. Mca territory large infarct with hemorrhagic transformation without mass Effect His clinical conditions and pupils not reacting is not correlating Treatment- single Antiplatelet+ statin Antiedema measure Head elevation (30°-45°) Bp monitoring- hydration Cardiologist opinion must be taken No LMWH due to already hemorrhagic transformation I THINK DECOMPRESSION Craniectomy ( neurosurgical standby for if needed) We should do close neuromonitoring After Settled his condition - Physiotherapy and aggressive rehabilitation
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CT brain hyperacute infarction Rt Temporoparietal MCA branch involvement. MRI BRAIN acte infarction rt MCA branch with brain edema with compression for lateral ventricle. NEEDS ICU observation . Rept CT if further deterioration to check for increase in edema . Rept CT 24 hrs or earlier. 38 yrs only - Case of young stroke. Work up for vasculitis including fasting serum homocysteine. Known case of CAD ,on antiplatelets. CHECK regarding the current antiplatelets ,if single add both ecosprin 150 mg & Clopidogrel . Add statin ,DVT prophylaxis,neuroprotective,rept cardiac evaluation .physio Complete work up for young stroke protocol
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Acute ischemic stroke with involvement of right mca territory Cause- atherosclerosis sec due to hypertension Treatment - give asprin Atorvastatin Mannitol Anti epileptics Physiotherapy Find out the cause of young hypertension Renal arterey Doppler Aldosterone rennin ratio 24 hr urinary metanephrine level Thyroid Lipid profile
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Cerebral Ischaemic stroke with Lt hemiplegia Cause Atherosclerotic process Give Aspirin atorvastatin Epsolin (precautionary) Mannitol and ofcourse start physiotherapy after a. Week Go for renal doppler24 hrs urinary metanephrine level Thyroid profile Lipid profile Homocysteine level
Rt mca infarct, inj LMWH S/C BD , STATIN , ECHO , CAROTID DOPPLER , TCD , di ABG ALSO , CXR / ECG, put on venti, maitntain airway , THIS pt might be require decompressive craniotomy if MLS , mass effect occur , rest supportive treatment ,
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Dx-Cerebrovascular accident-lt sided hemiplegia.cause-thrombotic infarct in rt parietooccipital region.(atherosclerotic ).sub clinical dx-HT -ischaemic heart disease -severe MR LVH global hypokinesia ef-15%. Metabolic alkalosis. Rx-1-immediate hospitalization in icu. 2-oxygen inhalation stat. 3-IV fluids. 4-Tab asprin 150 mg 1od. 5-Tab atorvastation 10mg 1od. 6-antiepileptic drugs. 7-inj mannitol. 8-inj pantaperazole iv 9-inj ondesterone iv. 10-care bbowel /bladder. Advise-CAG serum lipid profile thyroid profile RFT LFT USG.CBC urine complete. Optimum control of blood pressure and blood sugar estimation. Close monitoring and follow up of pt.
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MASSIVE RT CERIBRAL INFARCTION LT HEMIPLEGIA RX 1 MRI BRAIN & MRA 2 ECG & ECHOCARDIUM 3 BLOOD CREATININE & GFR 4 NO MANNITOL = IT WILL CAUSE REBOUND BRAIN EDEMA GLYCEROL PO 5 NO ANTEPLATELET RIGHT NOW -- MASSIVE INFARCTION 6 A PPI IV 7 ANTIBIOTIC IV 8 O2 9 CONDOME DRAINAGE 10 RYLES TUBE FEEDING 11 HEAD END SLIGTLY RAISED DECUBITUS HEAD TURNED TO ONE SIDE 12 CHANGE POSTURE SIDE TO SIDE 13 MOUTH THROAT TO CLEAR OF SECTRIONS 14 BP = TO BE KEPT 150 / 90 CCB BETTER ANTIHYPERTENSIVE ....IN CVA 15 PHYSIOTHERAPY 16 .CORTICOSTEROID = HAS NO ROLE
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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!
?CVE. Inj manitol 100cc bd. Inj clexane 60mg stat & od Inj clopitap 75 mg 4stat f/b 75mg od. Watch for seizures vomiting headach. relevant Inv. ECG ,lipid profile.
It M CA infarct adv lmwh treatment for HTN investigation for stroke in young example cardiac Echo homocysteine Vasculitis Workup
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