Right-sided weakness.

Chief Complaint A 50-year-old female presents with right-sided weakness. History Patient is diabetic and is on medication for the same. No other past medical history. No relevant family history. Vitals BP: 130/85 mmhg, Pulse: 79 bpm, Resp rate: 20 bpm, Temp: 98.9 degree F Investigations CT scan was done. Images are attached below. Diagnosis Please comment. Treatment Give your opinion on treatment also.

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Right sided weakness indicate left sided infarction, CT plain brain shows normal finding Infarction in early phase is not detected on CT plain brain, therefore assuming vascular blockage and interaction infarction - empirical thrombolytic therapy can be considered However, presence of fever raises possibility of infective etiology, look for systemic markers of infection, check for neck rigidity and look out for meningitis

Looks like a case of right sided weakness with left sided probable ischaemic infarct - but as CT scan is normal -a small infarct may not be seen on CT scan . A MRI scan of brain is indicated with cerebral angiography. In case of cryptogenic stroke - Even MRI may be normal . Thrombolysis with alteplase is questionable- without MRI scan . A combination of Aspirin 150 mg + Clopidogrel 150 mg + Atorvastatin 40 mg O.D can be started Addition of Citicholine + piracetam B.D can help early recovery

NCCT shows hypodensity left periventricular comparing rt side.,suggestive of hyperacute left boarder zone infarction. Suggest MRI brain with MRA fir better visualisation. Window period is already over. Start medical management as per stroke protocol. DM is an independent risk factor for stroke

ct appears normal study mri brain with angiogram plan check for window period if symptoms persists no contraindications present proceed thrombolysis for patient inj alteplase0.9mg/kg 10% bolus over 1min followed by rest in 1hr monitor vitals and abc neurosurgery consultation

Left mca territory ischaemic stroke As ct done early thats why only very sensitive sigh visible Loss of left grey white differentiation is there Must be under treatment of neurologist

Ischimic areas seen in lt substantial nigra extending to rt side Likely secondary to diabetes adv MRA

CT Scan image does not reveil any abnormality

CT normal. Adv angio

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