Case study 08102016

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9 Oct 2016 - General

A middle aged gentleman, with background of type 2 diabetes mellitus, hypertension, increased body mass index, smoking of 20 pack years, and hypercholesterolaemia, was admitted with sudden on-set of left side weakness involving his left upper limb and left lower limb, with left facial droop, and slurred speech, started around 1 hour ago. His wife did witnessed the event, and according to her, patient was helping her to clean the kitchen during that time, and suddenly experienced the symptoms of left sided weakness. On examination, the power of his left upper and lower limbs are both 2/5, left facial droop, and sensory inattention to the left side. His vitals - blood pressure - 165/89, pulse -92 irregular, temperature -apyrexia, respiratory rate-16, oxygen saturation on room air 98%. What is your diagnosis ?? what urgent investigation required and what will be your managment strategy ???

Yes, it can be either ischaemic stroke or haemorrhagic stroke. Given that patient did had irregular pulse, it seemed like ischaemic stroke with thromboembolic source will be most likely diagnosis. Given the period of onset was within 4.5 hours, urgent CT-Brain was required to rule out the possibility of haemorrhagic stroke, so that the patient can be given thrombolysis treatment for the ischaemic stroke. Ideally, CT-angiogram of the brain should be done together with the CT-brain, as some of th...
 (Total 123 words)
This is a very common presentation of STROKE or cerebrovascular accident. The diagnosis is: stroke with left sided hemiparesis with facial nerve palsy with DM with HTN and dyslipidemia.
An urgent CT scan of brain is required to identify whether the stroke is ischemic or hemorrhagic.
Management will differ based on the type of stroke. But in all cases urgent resuscitation with fluid management, control of DM etc is required. In case of ischemic stroke anti platelet or revascularization...
 (Total 102 words)