CASE OF STROKE

STROKE
• A stroke occurs when part of the brain loses its blood supply
and stops working. This causes the part of the body that the
injured brain controls to stop working.
• A stroke also is called a cerebrovascular accident, CVA, or
"brain attack.“

• The types of strokes include:

• Ischemic stroke (part of the brain loses blood flow)
• Hemorrhagic stroke (bleeding occurs within the brain)
STROKE
• Transient ischemic attack:
• TIA, or mini-stroke (The stroke symptoms resolve within minutes,
but may take up to 24 hours on their own without treatment.
This is a warning sign that a stroke may occur in the near future.)

• Hemorrhagic (heh-more-raj-ik) strokes :

• occur when a blood vessel in the brain breaks or ruptures. The
result is blood seeping into the brain tissue, causing damage to
brain cells.
• The most common causes of hemorrhagic stroke are high blood
pressure and brain aneurysms. An aneurysm is a weakness or
thinness in the blood vessel wall.
STROKE
Risk factors:
• Being overweight
• Being aged 55 years or older
• A personal or family history of stroke
• An inactive lifestyle
• A tendency to drink heavily, smoke, or use illicit drugs
STROKE
Symptoms of stroke are:
• Confusion, including trouble with speaking and understanding
• A headache, possibly with altered consciousness or vomiting
• Numbness or inability to move parts of the face, arm, or leg,
particularly on one side of the body
• Vision problems in one or both eyes
• Trouble walking, including dizziness and lack of co-ordination
DEMOGRAPHICS DATA OF PATIENT
Name: Kishorbhai Bidkar
Age:70 years
Gender: Male
DOA:4/12/17
DOD:14/12/17
Ipno:1712040221
• Patient is a K/C/O Hypertension since 4 years and no other
significant illness was found Medication for HTN is not known
• Patient has the C/O:
• Tingling sensation in right upper limb since yesterday and
gradually progress to right lower limb.
• Difficulty in walking
• Coughing from 2-3 months with expectoration
History of present illness:

• Patient was asymptomatic till the previous day evening then he

developed sudden onset of tingling in right upper and lower limb.
• Patient has developed numbness in the same limb but afterwards it
was relived.
• NO C/O:BIL pedal edama, headache , abdominal pain.
• P/M/H: H/O: HTN since last 4 years
• SURGICAL HISTORY :Nil
• Habbits: non smoker, alcoholic
parameter 4/Dc12 5/12 7/12 Normal range

Hematology

Hb 13 12.6 12.4 13-17g/dl

WBC 9100 7900 7900 4000-

11000cells/cmm

Platlets 3.25 3.112 2.856 1.5-4.5lac/cmm

PT 14/14

PTT 30/30

Renal function
test

Urea 18 19 11-45 mg%

Creatinine 0.8 1.1 0.6-1.3 mg%

parameters 4/12 5/12 7/12 Normal range

Electrolytes

Na 134 136 131 135-147 mEq/L

K 4.2 4 4.2 3.5-5 mEq/L

cl 103 103 100 95-105 mEq/L

Liver function
test

Billirubin 0.9 0.1-1.0mg/dl

SGOT 19 0-40 IU/L

SGPT 10 0-40 IU/L

SPECIFIC LABOLATORY INVESTIGATION:

• Brain MRI
• Lac of blood flow related enhancement is seen
• Non haemorrhagic acute infracts present in temporal, occipital
lobes and corpus collasum
• Thrombosis on left PCA segment and few chronic infracts in bilateral
periventricular region.

• USG abdomen and pelvis report

• In this it is stated that prostrate is enlarged with median lobe.

• Bilateral carotid Doppler test

• Intimal thickness on right side=1mm and on left side=1.1mm
• There is thrombosis of left side.
DRUG DRUG DOS FREQ. D D D DA D DA DA D DA D
(BRAND (GENERIC E A A A Y A Y Y A Y A
NAME) NAME) Y Y Y 4 Y 6 7 Y 9 Y
1 2 3 5 8 10

Inj. LMWH Low 0.4 BD + + + + +

molecular mg
weight
heparin

Tab - Aspirin 150 0-1-0 + + + + + + + + + +

Ecosprin mg

Tab - Cilacar Cilnidipine 10m 1-0-0 + + + + + + + + + +

g

Tab - Rosuvastatin 20m 0-0-1 + + + + + + + + + +

Rosumac g

Tab - Multivitamin 1-0-1 + + + + + + + +

Supradyn

Tab - Veltam Tamsulosin 0.4 0-0-1 + + + + +

mg
VITALS 1 2 3 4 5 6 7 8 9 10

BP(mm/hg) 204/ 144/ 144 124 136 146 146 146/ 148/ 140/
120 94 /94 /82 /88 /94 /90 90 80 82

Pulse(beats/min) 88 72 70 78 80 82 81 72 72 81

Temp(f) Afebr Afebr Afe Afe Afe Afe Afe Afeb Afeb Afebri
ile ile bril brile brile brile brile rile rile le
e

Fluid intake(ml) 300 150

Renal output (ml) 400 400

SOAP NOTE
SUBJECTIVE:
• Patient is a K/C/O Hypertension since 4 years and no other
significant illness was found Medication for HTN is not known
• Patient has the C/O:
• Tingling and numbness in right upper limb since yesterday and
gradually progress to right lower limb.
• Difficulty in walking
• Coughing from 2-3 months with expectoration
OBJECTIVE:
• Age:70 years
• Gender:male
• On examination all the hematological, renal function test , liver
function test, electrolytes was found to be normal.
• Brain MRI
• Lac of flow related enhancement is seen
• Non hemorrhagic acute infracts present in temporal, occipital lobes
and corpus collasum
• Thrombosis on left PCA segment and few chronic infracts in billatral
periventricular region.
• Bilatral carotid doppler test
• Intimal thickness on right side=1mm and on left side=1.1mm
• There is thrombosis in left PCA segment.
ASSESSMENT
• Based on the subjective & objective data it was found that
patient was suffering from : Stroke with (thrombosis of left
PCA with acute infract)
PLAN
• Goals of therapy
• The goals of treatment of acute stroke are
• to reduce the on going neurologic injury and decrease mortality
and long-term disability,
• prevent complications secondary to immobility and neurologic
dysfunction.
• Prevent stroke recurrence.
 DISCHARGE MEDICATION
Brand name Generic name dose route Frequen indication
cy

Tab -Rosumac Rosuvastatin 20mg PO 0-0-1 Helps to lower the bad

cholesterol
Tab -Cilacar Cilnidipine 10mg PO 1-0-0 Hypertension

Tab -Valtem Tamsulosin 0.4mg PO 0-0-1 improve urination in

men with benign
prostatic
hyperplasia (enlarged
prostate).

Tab -Supradyn Multivitamin PO 0-1-0

• Drug interactions:
• No drug interactions were found.

• Monitering parameters for drugs:

• Tab rosuvastatin:Cr at baseline; LFTs at baseline, then as clinically
indicated; CK at baseline if myopathy risk.
• Tab valtem: no monitering recommended.

• Patient education points:

• About disease:
• Stroke: The sudden death of brain cells due to lack of oxygen, caused by
blockage of blood flow or rupture of an artery to the brain.
• Sudden loss of speech, weakness, or paralysis of one side of the body can
be symptoms
• About drugs
• Rosuvastatin: It reduces levels of "bad" cholesterol and
triglycerides in the blood, while increasing levels of "good"
cholesterol
• Confusion, Rhabdomylosis dark and foamy urine are side effects.
• Tab Cilacar: indication- antihypertensive
• MOA: calcium channel blocker work by blocking calcium channels
• Hypotension ,drowsiness ,constipation , GRED are the side effects.
• Tab Tamsulosin: indication- improve urination in men with
benign prostatic hyperplasia (enlarged prostate).
• MOA: is an alpha-blocker that relaxes the muscles in the
prostate and bladder neck, making it easier to urinate.
• Dizziness, drowsiness, weakness;
• Nausea, diarrhea headache, chest pain; headache, abnormal
ejaculation, back pain, blurred vision; tooth problems.
• Lifestyle modification:
• Include quitting smoking
• Following a healthy diet
• Maintaining a healthy weight and being physically active.
• Try soft food such as egg, yogurt soup