Case (11)

[Kassim]

Ali is a 58-years-old, man who is both a husband and father. He is moderately obese,  and has smoked two packs of cigarettes a day for the past 30 years. He awakes one morning with weakness
on his right side. He is a bit confused, sees double, and his speech is slurred.
When he attempts to walk to the bathroom, he stumbles a few times and falls.
In the emergency department (ED) his wife states that Ali was so stressed before he went bed.  He was on Amlodapine 10mg OD, Metformin 500mg BD.   His family history is significant for a father who died of a myocardial infarction at 45 years of age.
O/E conscious, confused, not able to communicate well, weakness in his right side, and the mouth deviated to the left. His deep tendon reflexes are brisk on the right and there is a positive Babinski reflex on the right.

What is the most likely diagnosis?
Which blood vessel is most likely to be affected?
What further investigation would you order to confirm the diagnosis?
How would you manage if his BP was 220/119 In the Short time, and also in the long time?
What is the prognosis?
kassim

[Muna1]

Ali is a 58-years-old, man who is both a husband and father. He is moderately obese,  and has smoked two packs of cigarettes a day for the past 30 years. He awakes one morning with weakness
on his right side. He is a bit confused, sees double, and his speech is slurred.
When he attempts to walk to the bathroom, he stumbles a few times and falls.
In the emergency department (ED) his wife states that Ali was so stressed before he went bed.  He was on Amlodapine 10mg OD, Metformin 500mg BD.   His family history is significant for a father who died of a myocardial infarction at 45 years of age.
O/E conscious, confused, not able to communicate well, weakness in his right side, and the mouth deviated to the left. His deep tendon reflexes are brisk on the right and there is a positive Babinski reflex on the right.

What is the most likely diagnosis?
i think this is cerebrovascular accident

Which blood vessel is most likely to be affected?
Middle cerebral artery (MCA) occlusions

What further investigation would you order to confirm the diagnosis?
Noncontrast head CT scan
MRI
ECG

How would you manage if his BP was 220/119 In the Short time, and also in the long time?
acute reduction of BP in the event of a stroke does not necessarily benefit the patient. The initial rise in BP after a stroke is believed to act as a neuroprotective response to increase blood flow to the brain.
The initial drug of choice is labetalol (10-20 mg IV for 1-2 min) or nicardipine or Sodium nitroprusside .
control temp,control blood glucose
oxgen 100%
long term mangment
ASA 160- 325mg /day +Clopidogrel (Plavix) 75 mg/day
atrovastatin 10 mg BP-lowering medications include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs).

What is the prognosis?
For one quarter of all people who suffer a stroke, the cerebrovascular accident prognosis is good. Twenty percent of all stroke victims will die in the hospital. Cerebrovascular accidents are the third leading cause of death . people who survive a cerebrovascular accident, only about ten percent will recover most or total functioning. The cerebrovascular accident prognosis for half of all stroke survivors will leave them with some degree of long-term disability. Forty percent of all stoke survivors will require long term nursing care after a cerebrovascular accident
i hope it is the correct anwser.

[Muna1]

the prognosis in this case is bad becuse he is confused and he has h/o DM +HTN + His family history is significant for a father who died of a myocardial infarction at 45 years of age.

[Kassim]

yes its the correct answer.
kassim

[Admin]

Congratulations
The 15 points of this case goes to Muna1
Dr.Mahdi