PBL #2
Case 1
A 57 year old female complains of right-sided hemi paresis.
Investigations are orientated around the clinical presentation.
Taking the history of the patient may help in the diagnosis:
1. Duration:
2.
3.
4.
5.
i. acute --------------------> more alarming, may be a vascular
attack.
ii. Chronic---------------> tumor
Progression: ongoing or static?
Distribution: Upper and Lower limb involvement indicates either
disruption in the cervical spine or internal capsule.
Risk factors: diabetes, hypertension, vascular occlusive disease.
a. If it is a young patient: think of hemorrhages due to congenital
vascular malformations.
Associated symptoms:
a. Nausea, vomiting, headache---> may indicated increased
intracranial pressure (hemorrhage)
b. Seizures---> irritation of the cortex
Weakness= loss of power.
**You must exclude physiological abnormalities when you a diagnose a
patient functionally.**
Paresis vs. Plegia
Paresis: reversible
Plegia: Irreversible
An infarction is a region of hypodensity on a CT scan. It will NOT show until
after 6 hours of an attack.
Thus, early ischemic changes should be recorded by a diffuse scan.
-Hemorrhage: seen as a large white mass
-Tumor: is a non-vascular, chronic space-occupying lesion.
-If the patient is middle-aged, think of ANEURYSM
-If the patient is elderly, think of ISCHEMIA or HEMORRHAGE.
-Systemic diseases will cause both brain and limb ischemia
Diabetes will cause SMALL VESSEL DISEASE, which may lead to
strokes.
Lab tests are used to rule out systemic diseases.
*** Acute intervention--------> Catheterization (first 3-6 hours)
1. To ensure rapid recovery of the neurons
2. Given with anticoagulants
Rehabilitation is needed for CHRONIC MANAGEMENT.