stroke

1. CASE PRESENTATION
Stroke
By-Nagaraju B

2. Patient Name -xxx
IP/OP No -309/13
DOA - 1/4/13
DOD - 5/4/13
Department - Med
Unit -II
Age - 65years
Sex - Male
Weight -87kgs

3. SUBJECTIVE
Chief complaint/ History of Presenting illness:
Patient c/o slurring of speech, confusion x 2 days
weakness of right side since 1 day
deviation of angle of mouth
Previous history:
k/c/o Hypertension x 6 years
(Atenolol 50mg 1-0-0)
Smokes 20 cigarettes/day x 20 years and
consumes 6 ounces wine/day x 25 years
PastMedicationHistory/Allergy:
Nothing significant

4. Personal history:
Diet- Mixed
Appetite-Normal
Sleep-Slightly decreased
Bowel –Constipation+
Bladder- Regular
Habits- Smoking, Alcoholism
Physical examination : patient was conscious but not
responding to oral commands
power: right upper limb - 2/5 & lower limb - 3/5
Vital signs:
BP - 180/90mmHg PR – 60bpm
RR – 18cpm Temp – afebrile
Family history:
no f/h/o DM, HTN, Asthma, TB,
Stroke, Epilepsy
OBJECTIVE

5. P[-], I[-], C[-], C[-], L[-], E[-]
Systems :
P/A - soft, non tender
RS - NVBS+, no additional sounds.
CVS – S1S2+, no murmurs
CNS – Motor Loss-Hemiplegia, Hemiparesis
Provisional diagnosis :
? stroke

6. TEST TEST VALUE NORMAL VALUE
Hb (g/dl) 15.6 gm% 13-18
Total leucocytes counts
(cells/cmm)
6000 4000-11000
N (%) 75% 40-75
L (%) 22% 20-45
E (%) 03% 1-6
M (%) 00% 2-10
B (%) 00% 0-1
Platelets (cells/cmm) 3Lac 1.5-4.0 lakh/cmm
ESR 10 0-17 mmhr
Urine Routine Sugar: Nil Albumin: Traces
Urine Microscopy Pc: 1-2 Ep: 1-2 cells
LABORATORY INVESTIGATIONS

7. TEST TEST VALUE NORMAL VALUE
Sr. Cr (mg/dl) 1.1 0.2-1.4mg/dl
GRBS 70 70-160mg/dl
Ser. Cl- 102 Up to 103 mEq/L
Ser. Na+ 136 136-145mmol/L
Ser. K+ 3.8 3.5-5.1 mmol/L
Total-C: 201 130-200mg/dl
HDL-C: 34 30-70mg/dl
LDL-C: 167 60-130mg/dl
VLDL: 24 5 – 40mg/dl
TG : 151 25- 160mg/dl
ECG ST segment elevation
CT-Scan Moderate sized, well defined hypo dense lesion in
ganglion area

8. ASSESMENT
Based on the subjective & objective evidence the
patient was diagnosed to have ischemic stroke.

9. BRAND NAME GENEROIC NAME DOSE FREQU
ENCY
DATE DATE END
Kratol Inj mannitol 20%
IV
100ml 1-1-1 1/4 4/4
Aten-50 Tab. Atenolol 50mg 1-0-0 1/4 Cont-
Stromix-A Tab.Clopidogrel
+Aspirin
75/150mg 0-1-0 1/4 Cont-
Cholechek-10 T.Atorvastatin 10mg 0-0-1 1/4 Cont-
Nexpro-20 T.Esomeprazole
magnesium
20mg 1-0-0 1/4 For 4 wk
Inj.Neurocetam Inj. Piracetam 200mg 2-2-1 1/4 4/4
Inj Nitroject Inj.
Nitroglycerine
5mcg/min
IV
1-2-2 1/4 4/4
Angispan-TR T.Nitroglycerin 6.5mg 1-0-1 5/4 For 4 wk
Piramet1200 T.Piracetam 1200mg 1-0-1 5/4 For 4 wk
MEDICATION CHART

10. DAY 1
BP : 180/90 mmHg
PR: 60bpm
O/E : Patient was conscious but not
responding to oral commands
power: right upper limb - 2/5
lower limb - 3/5
Others: ECG: ST segment elevation
ADV: Hb, TC, DC, PLT, RBS, SERUM
Cr, UREA, ELECTROLITE,URINE ®, LIPID
PROFILE, CT- SCAN

11. DAY 2
PULSE: 65 bpm
BP: 160/90mmhg
O/E: Patient was conscious and
was responding to oral commands.
Advised to continue same
treatment referred to
physiotherapist

12. DAY 3
BP: 170/90
PULSE : 75bpm
Adv: Advised to continue the medication
as such

13. DAY 4
BP:160/76mmHg
PULSE : 80bpm
O/E ; Patient feels better
Power: 3/5 (UL)
4/5 (LL)
Adv: Patient was advised to cst

14. DAY 5
BP: 140/90mmHg
PULSE: 70bpm
Adv: CST

15. Suggestion to Physician-
No drug interaction is found.
PLAN

16. Advice to patient-
 Avoiding smoking
 Cutting down fat and cholesterol containing foods to
help reduce plaque build up
 Eating a healthy diet including plenty of fruits and
vegetables
 Limiting sodium in the diet, thereby reducing blood
pressure
 Exercising regularly
 Having 3 cup of green tea/ day
 Moderating alcohol intake
 Maintaining a normal weight
 Controlling blood pressure and keeping blood
sugars under control

17. THANK YOU…