A 70 year old male presented with weakness on the right side both upper limb and lower limb
08/06/2022
General medicine elog1
Hi, I'm Glory Evangeline 3rd sem medical student .This is an online E log book to discuss our patient's de-identified health data shared after taking his guardian's signed informed consent.This also reflects my patient centered online learning portfolio
A 70 year old male was bought to the causality with cheif complaints of weakness on the right side ( UL& LL) 3 days ago and drooping of saliva on the right side
History of present illness : Patient was fine 3days ago developed weakness completely on the right side
History of past illness :
3 yrs back He had the same situation of weakness on the right side and speech issues and treatment was done.
Patient had similar weakness on the right side with slurring of speech and drooping of saliva on the right side and treated.
HTN since 1 year
No history of diabetes
Treatment history:
3 years go Treated for weakness on right side.
Treated for HTN.
Familial history: Nil.
Personal history:
Consumption of alcohol 5 year ago.
Normal appetite
General Examination:
No pallor
No icterus
No cyanosis.
No clubbing of fingers.
No lymphadenopathy
No pedal edema
CNS Examination:
Conscious
Slurred speech.
Sensory :
7 th cranial nerve loss of nasolabial on the right side
Motor :
Power :. Right. Left
UL :. 0/5. 5/5
LL :. 0/5. 5/5
Tone :. Right left
UL : decreased Normal
LL :. Decreased. Normal
Provisional Diagnosis :
cerebral infarction, (ischemic stroke) Right hemiplegia .
Medications:
Cerebral infarction :
(Acute ischemic stroke)
1) Where is anatomical location of this patient's problem? (related to Macroanatomy)?
It is the clinical syndrome also know as Millard bulger syndrome, classical crossed brainstem syndromes characterized by a unilateral lesion of the basal portion of the caudal pons involving fascicles of abducens (VI) and the facial (VII) cranial nerves and the pyramidal tract fibers.
2) Why is the patient having this problem? (related to microanatomical pathogenesis as well as macro-social environmental events influencing it)
Microanatomical pathogenesis :
As white matter is more vulnerable to ischemia than grey matter , the areas of infarction are well shown by the myelin stain , Acute ischemic injury causes diffuse eosinophilia of neurons which are beginning to shrink , infiltration of a cerebral infarct by neutrophils begins at the edges of the lesions where vascular supply has remained intact ,after some days macrophages are seen along with surrounding rounding reactive gliosis ,remote small intracortical infarcts are seen as areas of tissue loss with residual gliosis.
Macro social environmental events may also influence this case as hypoxic condition is the main reason for the ischemic condition , extreme stress and shock may influence this case .
What are we doing about it? (pharmacological and non pharmacological interventions)
Pharmacological intervention :
1) T. Ecospirin.
2) T. clopidogel
3) T. Atorias
4) T. Pantoprazole
5) T. Riticodine + piracetam
6) T. Met XL
7) T. Lasix
Non pharmacological intervention :
CT scan
MRI scan
Vertebral angiography helps if the lesion is in the basilar artery
Physiotherapy
Regular on Excercises directed by physiotherapist.
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