Slurred speech with Hypertension
A 66 year old male presented to OPD once again with slurred speech and difficulty in walking History H/O similar presentation like a month before presented with slurred speech and BP in range of 210/137mmHg and had undergone a NCCT head which revealed Diffuse cerebral atrophy ?Chronic infarcts, he was then put on Telista CL and Nulong 10 at night etc later he discontinued medcines Vitals His BP today is 206/134 mmHg Pulse 81 RBS 117 mg/dl Hb1c - 6% LDL - C - 117 Non HDL 134 Management I have restarted the patient on following - Cap Rozudoc Gold 10 at bedtime, Tab Telista CL OD Tab Nulong 10 OD after dinner Tab Dytor 5 OD Multivitamin syrup Piracetam 800 BD PPI + Prokinetic 30 mins BBF Advised for visit to physiotherapist too and a salt restricted diet Please guide me for appropriate line of management for this patient
Old age pt with uncontrolled hypertension and senile atrophic brain and noncompliant as drop out the treatment hence varient hypertension aggravated cerebral stroke Your line seems to be in right direction But I will like to add ecosprin 150mg 1od and tab revorxuciban 10mg so as to keep thrombus dissolved
Chronic hypertension with Cerebral Trophy and others related complications. Needs further investigation and evaluation to conclude particularly angiography of brain , consideration of. Cerebral condition. Regular monitoring and constant evaluation required. Physiotherapy and reassurance will be more beneficial. Ecosprin 150mg od may add.
GERIATRIC CASE .. WITH .. ? SEVERE .. HT .. WITH .. CEREBRAL ATROPHY .. WITH .. ASSOCIATED .. COMPLICATIONS ..
Sir,it could be a case of Transient ischaemic attack (TIA).But the elevation in BP might point towards an Ischemia. Addition of Aspirin & clopidogrel together can be taken into secondary consideration.Mostly only clopidogrel would be enough rather than dual platelet therapy. Since CT doesn’t show any acute hemorrhagic changes sudden BP reduction can be deferred till a definitive cause is identified. But I won’t disagree with a Rx of clinidipine, Telmisartan. Would advise for a neurology consult along with MRI angiogram and carotid Doppler.
The present episode minor stroke/ TIA.TIA duration of symptoms is important which is not mentioned. Needs regular antiplatelets with statin. Needs good control of Hypertension. MRI is the ideal investigation
He has severe hypertension He needs antihypertensive medications - your choice of medication is good Monitor blood pressure
slurring of speech Rx saraswata churna or any of vacha preparation with vatanulomana drugs
Cases that would interest you
- Login to View the image
Infant brought by mother with H/O abN-behaviour and excessive crying, not properly sucking at breast, sometimes becoming cool and arching of trunk while crying, later becomes dull and inactive with head drop and Sp recovery Wandering from Ped to Ped for 2 > wk and I am the 3rd one. All r pt words. TB AGA LSCS and no H/O any NICU admission. Child admitted for evaluation MRI Head done and posted the images.
Dr. Chakradhar Maddela7 Likes18 Answers - Login to View the image
A 70 yr old patient presented with altered sensorium and irrelevant talkng since 1 day...no other comorbidities or drug history is present...Vitals were stable and no focal neurological deficit was seen...On initial investigations, he was found to have hyponatremia which was corrected but the patient remained in Altered Sensorium..MRI brain was done...comment on the management of this pt....
Dr. Hardik Ahuja2 Likes21 Answers - Login to View the image
76yrs old male normotensive and non diabetic presented with complaints of Acute generalized h eadache for 2days with left sided weakness and giddiness.Focal neurological deficits present with no sensory impairment.Bilateral Plantar flexor. N/h/o Alcoholic,CAD,HTN or trauma to head o/e Patient conscious,Oriented,GCS - 15/15. Vitals normal.All investigations normal. CT brain and ECG enclosed.
Dr. Prashant Ved1 Like23 Answers - Login to View the image
69yrs old male presented to casualty with H/o sudden onset right sided weakness(UL>LL) or monoplegia,Diaphoresis and chest haeviness today at about 2pm.Window period or Door to needle time is over. K/c/o DM and HTN on beta blockers for 3 to 4years o/e - Pupils - B/l 4mm RTL GCS - E3V5M6 Bp - 110/90mmhg on Inotropes,HR - 72/mt,BG-355mg/dl RR - 23/mt,Trop - T - +ve,CPK-MB - 55 INTERPRET CT SCAN WITH ECG BRAIN AND KINDLY SUGGEST FURTHER MANAGEMENT PLAN??
Dr. Prashant Ved2 Likes17 Answers - Login to View the image
65yr old female wth complaints of irrelevant talk, slurring of speech, extreme restlessness also suffering from psychiatric illness, not on any medications, pt now exhbtng all these fr the past 2 days
Dr. Deiva Vignesh26 Likes43 Answers
2 Likes