Concluded Case

LACUNAR INFARCTS - Management

62 years old male with gradual onset altered orientation- but conscious since last 2 months. O/Examination- All reflexes are normal but increased tone of flexor muscles with spasticity . No co - morbidities. MRI scan of brain - Multiple Acute lacunar infarcts involving the leff parietal lobe and genu of corpus callosum along with chronic ischaemic small vessel disease. Comments on Treatment- welcomed

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MRI brain shows multiple lacunar infarctions with featuresof CSVD Check for risk factors of stroke including fasting homocysteine,cardiac evaluation . Start on antiplatelet,statin,neuroprotective.Altered orientation needs more detailes. Is it memory impairment?Is he a smoker ,if so ad to stop smoking

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Lacunar infarcts . These are small infarcts (2–20 mm in diameter) in the deep cerebral white matter, basal ganglia, or pons, presumed to result from the occlusion of a single small perforating artery supplying the subcortical areas of the brain... It is defined as an acute stroke syndrome with a CT lesion compatible with the occlusion of a single perforating artery, consisting of a subcortical (basal ganglia, internal capsule, brainstem), small, sharply demarcated hypodense lesion with a diameter <15 mm.. In a multiple infract case, which seem to be in the scan image, 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis,

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Watch for GCS Limb power movement Pupil reaction Anti platelet IV.OPTINEURON IV.CERACETAM IV.FLUID Please also note past history of DM & HT with regular medication or not. As these factors also are causes of CVE. In past history if none of correlated with CNS abnormalities not found then 2 D echo + MRI brain angio will help to diagnose specifically leading coz of this CVE incidence . On discharge please advise him to continue with anti platelet + anti lipid & Anti HT / DM( If present) + advise modifying life style changing diet.

MRI brain shows multiple lacunar infarctions with featuresof CSVD Check for risk factors of stroke including fasting homocysteine,cardiac evaluation . Start on antiplatelet,statin,neuroprotective.Altered orientation needs more detailes. Is it memory impairment?Is he a smoker ,if so ad to stop smoking

Thank u@Dr. Manorama Rajan mem
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It's a suggestive case of Lacunar encephy with malacia, Give Tab, Ecosprin 75 mg, Tab. Clavix, Tab. Atorva, tab. Fortinerv, broad spectrum antibiotics, & antihypertensive with PPI, Do 2D Echo, Serial ECG, LIPID PROFILE, SERUM ELECTROLYTES, BUN, CONSULTANT NEURO PHYSCIAN

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Lacunar d koi Small infarct in deep cerebral white matter.and basal ganglia. This is acute stroke syndrome.with occlusion of single small perforating artery. 2.Types of small vessel disease could be distinguished durinf life

Lacunar infarct with ischemic changes Citicoline bd Piracetam bd Statin. Rosuvastatin bd Check for MRI brain Angiography BP, cholesterol lipid profile Ecosprin SOS

Ct angio must to detect sight of bleeding.
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According to film it shows the case of lacunar encephy See for hemocystine level Blood report Ecg 2decho Lipid profile N treat accordingly

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Lacunar infarct Small vessels affected Spasticity as result Aspirin75 mg clopidogrel75 mg od

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