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CASE PRESENTATION ON
CEREBROVASCULAR ACCIDENT
HAMMAD KC
IV TH PHARM . D
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PATIENT DETAILS

Name

IPID
: IPID0062194

Age/Sex
: 76/ Male

Admission Date : 18.06.19

Department
: Neurology (GW 5th floor)

Weight
: 70 Kg

Discharge Date : 24.06.19
: XYZ
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SUBJECTIVE EVIDENCES


CHIEF COMPLAINTS ON ADMISSION

c/o forgetting incidence , left hand weakness , deviation of angle of mouth since 1 day

c/o slurred speech since 2days

H/O fall from the bed
, Incontinence of urine
PAST MEDICAL HISTORY

k/c/o HTN since 20 yrs

k/c/o CVA × 5 yrs back
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5


PAST MEDICATION HISTORY

T.AMLONG 10 mg (amlodipine)

T.LOSAR 25 mg (Losartan)

T.DEPLATT 75 mg (clopidogrel)
ALLERGY

No allergy known
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

SOCIAL HISTORY

Diet
: Mixed

Sleep
: Irregular

Exercise
: nil
FAMILY HISTORY

father : k/c/o HTN, DM2, Angina

Mother
: k/c/o HTN , DM 2
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
PHYSICAL EXAMINATION


76 years old male patient was admitted in general ward (5th floor) was semi-conscious and
disoriented to time , place and surrounding.
SYSTEMIC EXAMINATIONS :
CVS
: S1 S2 heard
RS
: B/L Air entry (+)
Per Abdomen
: Soft
CNS
: Disoriented , semiconscious , Drowsy
Local examination: Right UL/LL: 5/5
left UL/LL: 3/5
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OBJECTIVE EVIDENCES

VITAL SIGNS

B.P
: 160/100 mmHg

R.R
: 20 cpm

P.R
: 128 bpm

Temperature : Afebrile

LABORATORY DATA
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PARAMETER
Hb (g/dL)
VALUE
13.2
NORMAL VALUE
13 – 18 g/dl
pH
7.38
7.35 - 7.45
TLC
8500
4000 – 10000 cells/cu.mm
Platelet
3.6
1.5 – 4.5 lakhs/cu.mm
Total Cholesterol
225
Less than 200 mg/dl
LDL
147
Less than 100 mg/dl
PT
10.5
11 - 15.8 sec
INR
0.6
0.8 – 1.2
GRBS
145
79 – 160 mg/dl
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
RADIOGRAPHIC DATA

X-RAY
bone
: lung field are clear , cardiac size is normal , osteoporosis seen in chest

MRI SCAN : Mild to moderate acute infract in right superior cerebral peduncle ,
infract in bilateral middle and inferior cerebral peduncle.

ANGIOGRAM : bilateral internal carotid artery show intimal thickening.
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PATIENT ASSESMENT
SUBJECTIVE EVIDENCE

C/O forgetting incidence ,Deviation of angle of
mouth, H/O fall from bed , H/O left hand
weakness , H/O incontinent of urine , c/o
slurred speech.

Past medical and medication history evidences

Systemic examination evidences like CNS

Local examination of arms
OBJECTIVE EVIDENCE

LAB investigation like BP, PR, Total cholesterol ,
PT, INR, LDL

MRI SCAN : mild to moderate acute infract in
cerebral peduncle

ANGIOGRAM ; Bilateral internal carotid artery
internal thickening
PATIENT ASSESMENT
Based on the subjective and objective evidence the patient was diagnosed with
CEREBROVASCULAR ACCIDENT (CVA)
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
GOALS OF TREATMENT

To minimize the signs and symptoms of stroke

reduce ongoing neurologic injury and decrease mortality and long-term disability,

prevent complications secondary to immobility and neurologic dysfunction

prevent stroke recurrence.

To maintain normal vitals

To improve quality of life & avoid fresh complaints.

To provide non-expensive & effective treatment.
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PLANNING

DRUG CHART
BRAND NAME
GENERIC NAME
DOSE
FREQUENCY
DAY
INJ.HEPARIN
Heparin
5000U
1-1-1
Day 1 – 3
Inj.STROCIT
Citicoline
250mg/ml
1-0-1
Day 1 – 3
T.COLIHENZ
Citicoline
500mg
1-0-1
Day 4 – 5
INJ.LEVIPIL
levetiracetam
500mg
1-0-1
Day 1 - 4
T.ATORVA
Atorvastatin
20mg
0-0-1
Day 1 - 5
T.BETALOC
Metoprolol
25mg
1/2-0-1/2
Day 1 - 3
T.PAN
Pantoprazole
40mg IV
1-0-1
Day 3 - 5
T.ECOSPRIN
Aspirin
150mg
0-1-0
Day 3 - 4
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
DRUG CHART
BRAND NAME
GENERIC NAME
DOSE
FREQUENCY
DAY
Syp.POTKLOR
Potassium chloride
15ml
1-1-1
Day 2 - 5
Syp.CREMAFIN
Mg(OH)² , Liquid paraffin
30ml
1-0-1
Day 3 - 5
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
PROGRESS CHART
DAY 1
DAY 2
Pt. was admitted with given complaints and kept under observation in ICU
for 48 hrs and patient have c/o hematuria
All vitals checked and reported.
No fresh complaints.
DAY 3
Patient became completely conscious, vitals checked and reported
Complaints of constipation
DAY 4
Comprehension of speech
Mild dysarthria
No c/o blood in urine , headache , vomiting
Requested for discharge
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
GOALS ACHIEVED

Disease progression is stopped and symptoms are improved

All vitals came to normal

Quality of life improved.
PLANNING

SUGGESTION TO PHYSICIAN

Drug interactions
1. Heparin + Aspirin : result in potentiated risk of bleeding complication
close monitoring with dose adjustment according to the INR reading.

Relevant investigation like ECG and CT scan reports are not included.

Frequency of the past medications is not provided.
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
PATIENT COUNSELLING

Disease related : Cerebrovascular accident also called stroke which is a
condition in which the damage to the brain from interruption of the blood
supply.

Pharmacotherapy related :

Citicoline is used for stroke , it’s a nerve protecting medicine , nourish and protect
nerve cell

Heparin and aspirin is used to prevent blood clots

Atorvastatin is used to control the blood cholesterol (HMG CoA reductase
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
Life style and diet modifications :

advised to take low fat , slow salted food

Avoid whole milk , try skim or non fat

Reduce fatty meat , egg yolk , liver

Increase intake of nuts , seeds , dry beans

Increase and promote intake of vegetables and fruits like banana , carrot ,
beetroot, apple etc…

Learn new ways of cooking like baking or broiling instead of frying
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
SUMMERY
Pt. got admitted on emergency basis with chief complaints relevant investigation is done like chest X Ray ,
ECG , MRI scan , MRI Angiogram to confirm stroke.
Hence treatment is started on basis of subjective and objective evidence with drugs like inj.LEVIPIL ,
INJ.STROCIT , T.ATORVA , T.DEPLATT etc..
Later patient improved symptomatically and discharged on following advise
T.DEPLATT 75mg 0-0-1
3 days
T.ATORVA 20mg
6 days
T.PAN
40mg
0-0-1
1-0-1 6 days
Review the doctor after 1 week in OPD
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