بسم الله الرحمن الرحيم CVA Academic group OF internal medicine - Revision note of CVA- 2010 Dr. Mohamed Eisam Elhag Mahmoud MBBS, Alneelain University Faculty of Medicine Note: Dr. Mohammed Isam Al-Hajj does not have any financial relationships to disclose nor will he discuss any non-approved drug or device uses.
Normal smelling, no visual disturbance, no double vision , no affection of eyes movment, difficult in mastication,affect of face sensation, jaw hang, deviation of mouth, accumulation of food ,loss of hearing, balance disturbanc , change in voice, difficult in swalowing, no diffecult in speech, can rise his shoulder, rotate his neck.
# social history: housing condition , educational level,jop,health insurance, sibling =>(to know who is take care of pt.) ,bad habites->smooking,alcoholic. Classes(low/modrate/high)socioeconomic class.
CVA, Rt. Side hemiplegia due to left cortical lesion which result of Embolism from cardiac source “mitral stenosis complicated by atrial fibrillation “ associated with Rt. UMN Fascial Nerve palsy “ uncrossed hemiplegia” , pt. has motor aphasia, now pt. is improved slightly .
Contralateral hemisensory loss & ipsilateral incoordination.
Q- what is the nature of lesion? Haemorrage Infraction embolism thrombosis Dramatic onset Occure when pt in his/her ordinary activity Sudden onset with max. intensity at the begin Rapid onset when pt. weak up from sleep then within hours weakness at maximum onset. Also condition associated with: Vomiting Convulsion fever Usually there is clear source of embolism. Ex. . cardiac -> preceded palpitation . Fat embolism ” bone fracture” . air embolism . pulmo. Embolism -> VSD “paradoxical embolism” Source: . HF . MI
Q- What is Door needle time mean in treatment of stroke?
If the pt. present within 1 st 3 hour “befor cytotoxic oedema formation” We can give Thrombolysis after exclude haemorrage & We can give Asprin safty, the best thrombolytic is => t.PA ( S/E: increase haemorrage size)