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A Case of Acute Ischemic Stroke With Left Hemiparesis

A 60-year-old female patient presented with weakness on the left side of her body and was diagnosed with an acute ischemic stroke. Medical history included diabetes and hypertension. Tests showed abnormalities in blood work and imaging found lacunar infarcts in the brain. She was treated with medications to prevent blood clots and reduce risk factors. Physical therapy was also recommended to address muscle weakness before discharge with medications including aspirin and statins.

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Safoora Rafeeq
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301 views

A Case of Acute Ischemic Stroke With Left Hemiparesis

A 60-year-old female patient presented with weakness on the left side of her body and was diagnosed with an acute ischemic stroke. Medical history included diabetes and hypertension. Tests showed abnormalities in blood work and imaging found lacunar infarcts in the brain. She was treated with medications to prevent blood clots and reduce risk factors. Physical therapy was also recommended to address muscle weakness before discharge with medications including aspirin and statins.

Uploaded by

Safoora Rafeeq
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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A CASE OF ACUTE ISCHEMIC

STROKE WITH LEFT


HEMIPARESIS
ACUTE ISCHEMIC STROKE
 Ischemic stroke is characterized by the sudden loss of blood
circulation to an area of the brain, resulting in a corresponding
loss of neurologic function. Acute ischemic stroke is caused by
thrombotic or embolic occlusion of a cerebral artery .
 Hemiparesis is weakness on one side of the body. The patient

can still move the affected side of your body, but with reduced
muscular strength.Hemiparesis or one-sided (“hemi”) weakness
(“paresis) affects about 8 out of 10 stroke survivors, causing
weakness or the inability to move one side of the body.
 An ischemic stroke occurs as the result of atherosclerosis, which

is a condition where fatty deposits or plaque build up in the


body's blood vessels.
SIGNS AND SYMPTOMS:
 Sudden numbness or weakness of the face, arm or leg, especially

involving one side of the body.


 Sudden confusion, trouble speaking or understanding.
 Loss of vision in one or both eyes.
 Trouble walking, dizziness, loss of balance or coordination.
 Sudden, severe headache with no known cause.

RISK FACTORS:
 Being overweight or obese and physical inactivity
 Blood pressure readings higher than 120/80 mm Hg
 Cigarette smoking or exposure to secondhand smoke
 High cholesterol
 Diabetes
 Cardiovascular disease, including heart failure, heart defects, heart

infection or abnormal heart rhythm


SOAP FORMAT
SUBJECTIVE DATA
 A 60 years old female patient was admitted in the
neurology department with the chief complaints of pain
and weakness in left upper limb and lower limb
associated with muscle fatigue.
 The patient is suffering from DM+ and HTN+, and is

on Tab. Glinil-M BD and Tab. Telmavas 40mg OD


respectively.
 Patient is conscious but confused.
OBJECTIVE DATA
 O/E: Weakness in the left upper and lower limb. Patient is
conscious and confused.
The following tests were advised
 CBP
 Serum electrolytes
 Blood urea
 Serum creatinine
 ECG
 CXR- AP
 2D Echo
 Carotid Doppler
 CT Brain Plain
ABNORMAL VALUES

TEST FINDINGS NORMAL VALUE

HAEMOGLOBIN 10.5g/dl 11.0-17.0g/dl

POTASSIUM 6.2mmol/l 3.5-5.0mmol/l

BLOOD UREA 51mg/dl 10-45mg/dl

SERUM CREATININE 2.1mg/dl 0.6-1.5mg/dl

RANDOM BLOOD 156mg/dl 79-140mg/dl


SUGAR
 CT BRAIN-PLAIN: Multiple small lacunar infarcts
noted in white matter region. Mucosal thickenings
noted.
 2D ECHO DOPPLER REPORT: Fair LV systolic

dysfunction. Grade I diastolic dysfunction of LV.


 CAROTID DOPPLER: left and right carotid system

shows diffuse intimal thickening.


ASSESSMENT
 PROBLEM 1: For ischemic stroke
MEDICATIONS: Inj. Clexane (Enoxaparin sodium) 40mg SC OD
Tab.Atorvas (Atorvastatin)20mg OD
Tab. Clopitab (Clopidogrel)75mg OD
 PROBLEM 2:To prevent blood clots
MEDICATIONS: Tab. Ecosprin (Aspirin) 150mg OD
 PROBLEM 3: Diabetes mellitus type 2
MEDICATIONS: Tab. Glinil-M(Glibenclamide+Metformin)5mg+500mg
BD
 PROBLEM 4: To reduce blood pressure
MEDICATIONS: Tab. Met-XL (Metoprolol extended release)25mg OD
 PROBLEM 5: To prevent acidity
MEDICATIONS: Inj. Pan (Pantoprazole) 40mg IV OD
 PROBLEM 6:Muscle weakness
MEDICATIONS: IVF NS 0.9% infusion @30ml/hr
 PROBLEM 7: Nervous disorder
MEDICATIONS: Tab. Lupirtin P (flupirtine
100mg+paracetamol/acetaminophen 325mg) OD
TREATMENT CHART
MEDICATIO GENERIC DOSE RO FREQU DAY 1 DAY 2 DAY 3 DAY 4
N NAME A ENCY
Inj. Clexane Enoxaparin 40mg SC OD  _ _ _
sodium
Tab. Ecosprin Aspirin 150mg PO OD    

Tab.Atorvas Atorvastatin 20mg PO OD    

Inj. Pan Pantoprazole 40mg IV OD    

Tab. Glinil-M Glibenclamide+ 5mg+50 PO BD    


Metformin 0mg
IVF NS Normal saline 30ml IV EVERY    
HOUR
Tab. Clopitab Clopidogrel 75mg PO OD _   

Tab. Met-XL Metoprolol 25mg PO OD _   


extended release
Tab. Lupirtin P Flupirtine + 100mg+ PO BD    
Paracetamol/Ace 325mg
taminophen
DAY NOTES
 DAY 1:
C/O: weakness in left upper and lower limb since morning. No H/O stroke in
past, no H/O seizures, no H/O CAD.
O/E: Patient is conscious, confused.
Vitals: Temp-98.6 F, BP: 150/90 mmHg, PR: 90b/min, RR: 22/min, CNS- left
UMN palsy, power of left UL-2/5 and of left LL-3/5, power of right UL and LL-
5/5, locomotor system- left hemiparesis, RBS-156mg/dl
 DAY 2:
C/O: Burning micturition, Haematuria+
O/E: Patient is conscious, communicating, confused.
Vitals: Temp-98.6 F, BP-110/80mm Hg, PR: 88b/min, RR: 22/min
 DAY 3:
No fresh complaints, haematuria subsided. Patient is conscious and alert. Vitals
are stable.
 DAY 4:
No new complaints. Vitals are stable. Patient is conscious, communicating,
obeying commands. Patient can be discharged.
PLAN
 DISCHARGE MEDICATIONS:
TAB. ECOSPRIN(ASPIRIN)150mg PO OD
TAB. PAN (PANTOPRAZOLE) 40mg IV OD
TAB. GLINIL-M (GLIBENCLAMIDE+METFORMIN)5mg + 500

mg PO BD
TAB. MET-XL(METOPROLOL EXTENDED RELEASE)25mg
PO OD
TAB. LUPIRTIN P (FLUPIRTINE + PARACETAMOL /
ACETAMINOPHEN)100mg+325mg PO OD
 LIMB PHYSIOTHERAPY WAS ADVISED.
 DURATION OF THERAPY: 7 DAYS
 REVIEW IN OP AFTER 7 DAYS
PHARMACIST INTERVENTIONS
 Aspirin + Enoxaparin and Aspirin + Clopidogrel: Either increases toxicity of the
other by pharmacodynamic synergism. Monitor closely. The need for simultaneous use
of low dose aspirin and anticoagulant or antiplatelet agents are common for patients with
cardiovascular disease, monitor closely.
 Pantoprazole + Clopidogrel: Pantoprazole decreases effects of clopidogrel by affecting
hepatic enzyme CYP2C19 metabolism. Hence monitor closely. It may be substituted
with a H2 receptor antagonist.
 Metoprolol + Aspirin: Metoprolol and aspirin both increase serum potassium. Use
caution/monitor.Do not coadminister metoprolol and aspirin to maintain potassium
levels.
 Enoxaparin increases the risk of bleeding. Avoid its use with other medicines like
Aspirin and NSAIDS that affects the bleeding risk. Take Ecosprin with food to avoid the
risk of bleeding. Discontinue the drug in case of severe bleeding.
 Aspirin and clopidogrel are used together for their additive antiplatelet and antistroke
effect. Caution is recommended especially in patients at risk of bleeding. Patients should
be counseled to avoid any other over the counter salicylate products.
 Metoprolol must be started at a very low dose and carefully uptitrated and monitored.
 Serum potassium levels are likely to be increased in patients with poorly controlled type
2 DM. Patient should be counseled to take the medications regularly .
PATIENT COUNSELLING
REGARDING DISEASE:
 Ischemic strokes occur when the arteries to your brain

become narrowed or blocked, causing severely reduced


blood flow (ischemia). The most common ischemic strokes
is a thrombotic stroke. A thrombotic stroke occurs when a
blood clot (thrombus) forms in one of the arteries that
supply blood to your brain.
 After a stroke, it's common to experience weakness or

paralysis on one side of the body, depending on which side


of the brain the stroke occurred. Left-sided weakness or
paralysis is caused by an injury to the right side of the
brain.
REGARDING MEDICATIONS:
 Swallow Ecosprin tablet as a whole. Do not chew,

crush or break it and to be taken with food.


 Tablet Atorvas may be taken with or without food,

but it is better to take it at a fixed time.


 Take Pantoprazole atleast 30 minutes before meals.
 Avoid Met XL 25 mg Tablet with high-fat meals such

as olive oil, nuts & seeds (Brazil nuts), dark


chocolate, butter and meat.
 Do not miss the dose and take medicines on time.
REGARDING LIFESTYLE MODIFICATIONS:
 Avoid foods like fatty meats, butter and cream, which are

high in saturated fat.


 Boil foods instead of frying.
 Maintain the normal blood glucose levels and check

regularly.
 Maintain the normal blood pressure.
 Reduce protein intake and increase the fiber in the diet to

lower creatinine levels.


 Limb physiotherapy is advised for hemiparesis.
 Use assistive devices like cane or walker and stay active

to keep muscles engaged.


THANK YOU!!

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