Right parietal infarct

Chief Complaint A 63 y/o male complaints of headache for 1 month, vomiting & slurred speech for 4 days. History Patient has h/o bladder cancer & undergone chemotherapy & radiotherapy. Examination Patient has right-sided weakness. unsteady walk & difficulty in performing motor tasks. Investigations No evidence of tumor recurrence. CT brain shows an infarct in the right parietal lobe. MRI brain shows infarction in these areas, extending into the posterior temporal of the other side and parietal regions. Treatment Discuss the treatment plan.

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? BRAIN PATHOLOGY.. ? CEREBRAL INFARCTION..WITH.. ASSOCIATED COMPLICATIONS.. ? ISCHEMIC .. DEGENRATIVE ..CEREBRAL PATHOLOGY.. NEED'S.. NEUROLOGISTS OPINION..

Tnx Dr Ashok Leel sir
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Known case of infarction in rt parietal extending to occipital Causing RCA rt sided paralysis with speech problem Known case of ca bladder Do pet scan Lmwh bd aspirin150 od Atorva80 mg od Opinion of neurologist Oncologist

Rt sided hemiparesis and infarct in rt parietal area is technically unacceptable. Better to post ct/mri film In view of past history of bladder cancer with chemo and Radiotherapy One must know the risk related with it.. As bladder cancers are highly vascular may bleed profusely if risk/benifit not assessed with treatment plan Discussion films with your neurologist

SINCE THERE. IS. HISTORY. OF.. ... . U. B. CARCINOMA... .. ""THERE. IS. RESEARCH. BASED. EVIDENCE.... IN. CASES. OF TRANSITIONAL CELL. CARCINOMA....U B. . .... THAT. EVEN. AFTER. A. LONG. REMISSION. PERIOD. ..AFTER. ...SYSTEMIC. CHEMOTHERAPY...... ..THERE. ARE. CHANCES. OF.. BRAIN. METASTASES..."" .. SO. NEEDS FURTHER. EVALUATION... .. A. NEWER. METHOD. ..FOR .. DIAGNOSIS...IN. SUCH. CASES... ...COMBINES.. ..BOTH. ..P E T. SCAN. AND. C T..SCAN.. AND. IS. MORE ACCURATE IN. DIAGNOSING... BRAIN. METASTASES POSSIBLY DELAYED. PRESENTATION ..EITHER. AS.. METASTASES OR INFARCTS

Delayed presentation... so just supportive care with Aspitin and anti lipid therapy.. moderate intensive dose.

Multiple cerebral infraction and cerebral pathology. Needs further investigation and evaluation particularly CT angiography of brain and neck. Constant evaluation and regular monitoring required.

Thanks Dr Kute Ankush
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