Concluded Case

Acute infarction with hemorrhagic transformation Rt MCA and ACA territ

72 yr old ,Male presented with acute onset of left sidedweakness on 26 feb 2021 , with the back ground history of systemic hypertension ,CAD with post CABG and Types DM. Chief Complaints On 26 feb 2021,while watching the news in the evening, he developed left sided mild weakness. He could get up immediately and was able to walk with mild support An hr later he felt better. The next day morning he noted weakness of left side with difficulty to hold things and unable to walk unassisted.Denied having any headache or vertigo but while taking the history he stated that he is getting headache after attending the OPD. History Known case of systemic hypertension 20 yrs CAD post CABG 10 yrs ago ,detected to be diabetic sincec2017 Vitals Afebrile,BP 140/ 90 mmhg HR 70/ mt Physical Examination Fully concious ,communicating well . Left sided UMN facial weakness noted Left upper limb gr 3/ 5 ,left lower gr4/ 5. DTRs hyperactive left side except absent ankle jerks with upgoing left plantar. Intact sensations. No bruit over the carotids or vertebrals. Investigations CBC normal FBS 128 mg / dl,HbA1c 7.4% ,renal functions normal. Lipd panel HDL 27 mg/ dl LDL 148mg/ dl( N <100).Normal other bloid work up. ECG old inferior wall MI changes with normal cardiac markers. Diagnosis Stroke, details keeping for conclusion Management Cadiac evaluation done. Started stroke management as per stroke protocol. Evaluated by the endocrinologist also.Already started physiotherapy

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Thsnks Curofy and all other answeres. MRI findings are more important in this case.T2/ FLAIR hyperintendities showing diffusion restriction on Rt frontal lobe involving cortex,subcortical and white matter,insular cortex and also in Rt high frontal lobe in the parasagittal region Blooming artifacts seen with on SW1 suggestive of ACUTE INFARCTION WITH HEMORRHAGIC TRANSFORMATION INVOLVING RT MCA AND ACA TERRITORY. Cardiac evaluation also done and excluded intracardiac thrombus. Patientis improving,planning to discharge after 2days

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Thsnks Curofy and all other answeres. MRI findings are more important in this case.T2/ FLAIR hyperintendities showing diffusion restriction on Rt frontal lobe involving cortex,subcortical and white matter,insular cortex and also in Rt high frontal lobe in the parasagittal region Blooming artifacts seen with on SW1 suggestive of ACUTE INFARCTION WITH HEMORRHAGIC TRANSFORMATION INVOLVING RT MCA AND ACA TERRITORY. Cardiac evaluation also done and excluded intracardiac thrombus. Patientis improving,planning to discharge after 2days

Rt MCA territory ischaemic stroke Initial transients weakness f/b increased weakness s/o stuttering stroke Characteristics of Large artery atherosclerosis In this case vascular imaging s/o ICAD in anterior division of RT MCA Although underlying history of cardiac disease is there Pt must be evaluated for cardioembic stroke by Echo and holter

Hemiparesis is weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing. One-sided weakness in your arms, hands, face, chest, legs or feet can cause:  Loss of balance Difficulty walking  Impaired ability to grab objects  Decrease in movement precision  Muscle fatigue  Lack of coordination Where your stroke occurred in the brain will determine the location of your weakness. Injury to the left side of the brain, which controls language and speaking, can result in right-sided weakness. Left-sided weakness results from injury to the right side of the brain, which controls nonverbal communication and certain behaviors. Ataxia: Injury to the lower portion of a person's brain may affect their body's ability to coordinate movement. The result is referred to as, 'ataxia,' and might lead to difficulties with walking, balance, and posture. Pure Motor Hemiparesis: Pure motor hemiparesis is the most common type of hemiparesis. People who experience this type of hemiparesis have weakness in their leg, arm, and face. The condition may affect the person's body parts equally, or it may affect one body part more than others. Ataxic Hemiparesis Syndrome: Ataxic hemiparesis syndrome involves weakness or clumsiness on one side of a person's body. The person's leg is often more affected than their arm. The symptoms happen over a period of hours to days. Treatments include: Modified constraint-induced therapy (mCIT). It forces you to use the weakened part of your body. Regular practice can improve nerve function.  Electrical stimulation. The procedure consists of placing small electrical pads on the weakened muscles of your affected body part. An electrical charge helps your muscles contract. Many electrical stimulation devices are covered by insurance and can be used at home. Cortical stimulation. A tiny electrode is placed on the dura, the tough membrane that covers your brain. The electrode sends an electrical current to your brain while you undergo rehabilitation exercises. Mental imagery. Imagining movement of the affected part of the body activates areas of the brain and muscles as if you’re doing an activity. The nerves in the brain involved in visualization and physical movement overlap, making this an effective activity when paired with other therapies for one-sided weakness. Assistive devices. Braces, canes, walkers and wheelchairs can increase strength and movement. An ankle-foot orthosis brace can help control your ankle and foot. A physical therapist can recommend the appropriate device. Repeated practice and regular activity will help increase control and flexibility and re-establish nerve circuitry. You can learn activities to do at home that will help continue recovery after inpatient therapy. Always consult a health care professional before starting these exercises. Occupational Therapists Cortical Stimulation Botox/Baclofen Motor Imagery (MI)

Mca infarct due thromboembolism. tpa given madam

Infarct

Thank you doctor
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Infarct. Thanks for sharing.

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