Stroke caused due to occluded artery.

2.  Michael is a 61 year old Senior Partner in a
Law Firm. While eating breakfast Michael
experienced sudden onset slurring of
speech, had facial droop on his left hand
side with weakness in left side upper and
lower limbs. Michael's friend Dr Nainika
spotted these sudden onset of symptoms
and immediately called for an ambulance,
which arrived within 15 mins.

4.  Hypertension Grade 1 - Dx 5 years ago
 Atrial fibrillation
 Prediabetes - Dx 3 years ago

5.  Vitals:
 BP 140/90 mmHg
 Pulse 75
 Physical Exam:
 FAST +ve
 Left Facial Droop
 Left Motor Weakness: Upper Limb 0/5, Lower
Limb 2/5
 Slurred Speech

6. Vitals:
 BP 145/90 mmHg
 Pulse 82
Physical Exam:
 Confusion
 Left Facial Droop
 Slurred Speech
 Left Motor Weakness Upper Limb 0/5, Lower
Limb 2/5
 Decreased Tone
 Altered Sensation
 Mild Left Sided Neglect

9.  Labs:
 INR 1.2
 Glucose 120 mg/dL
 CT:
 Non contrast scan was performed to exclude
hemorrhage
 Provisional diagnosis of Acute Ischemic
Stroke was made, patient was treated with
intravenous Tissue Plasminogen Activator (tPA)
0.9 mg/kg at 1 h 54 min after symptom onset.

10.  CTA (CT angigraphy)
 Hyperdensity in the M1 Segment of the Right
Middle Cerebral Artery, with no other signs,
suggestive of an Ischemic Stroke noted.
 Provisional diagnosis of Acute Ischemic
Stroke secondary to occlusion of the M1 was
made.

13.  MRI:
 Multimodal MRI Scan completed at 3 h 09 min
after symptom onset demonstrated Ischemic
Changes confined predominantly to the Right
Middle Cerebral Artery
 Perfusion-weighted MRI showed larger
perfusion abnormality, indicating presence of a
substantial volume of potentially salvageable
penumbral tissue.
 Time-of-flight magnetic resonance
angiography showed a loss of signal in the
Right Internal Carotid Artery and Middle
Cerebral Artery.

14.  Cerebral Angiography
 Cerebral angiogram performed post MRI
demonstrated Occlusive Thrombus extending
from the Right Internal Carotid Artery Origin
through the Right Middle Cerebral Artery Trunk.
 Recanalization was attempted by Endovascular
Thrombectomy performed 4 h 19 min after
symptom onset

16.  Thrombolysis & Endovascular
Mechanical Thrombectomy:
 An endovascular thrombectomy is the
removal of a thrombus (blood clot) under
image guidance.

18.  Patient had full recovery after recanalization and
was discharged 5 days later.
 Prevention for secondary stroke
 Anti platelet therapy – Aspirin(50 mg) + clopidogrel
for 90 days and the aspirin alone
 Life style modification.
 Maintaining healthy BMI.
 diet modification by reducing the intake of excess
carbohydrates and fatty foods
 Fast walking for 30 min at least twice a week
 Reduce BP and decrease salt intake.
 Physiotherapy