Case Discussion and Plan

1. 19TH ANNUAL CONFERENCE OF
CEREBROVASCULAR SOCIETY OF
INDIA
WORKSHOP
13th SEPTEMBER 2019
Dr Fakir Mohan Sahu
MCh Neurosurgery
AIIMS Bhubaneswar

2. A 73/F, presented on dt. 11/08/2019
C/o:
 Left sided neck pain: :3 wks
 Weakness in Right UL and LL(sudden onset) :3 wks
 Loss of speech(comprehension preserved) :3 wks
-No h/o LOC, Seizure, Vomiting
Past h/o:
 HTN(35 years)
 DM type 2 (1 year)
 Impaired RFT-creat-1.6

3. Average built and nutrition
Bed-ridden, requires constant nursing care
Afebrile
PR-78/min
BP-124/68 mmHg
RR-22/min
Spo2-98%

4. CNS EXAMINATION
Higher mental function:
 Conscious, oriented
 Following command
 GCS:E4V2M6
Cranial nerve: intact
Motor system:
 Power Right UL 1/5, LL 2/5
 DTR- exaggerated on right UL and LL
 Plantar : right upgoing, left down going
Superficial reflexes: normal
Sensory system-intact
Cerebellar sign- absent

5. MRA BRAIN(07/01/2019) MRI BRAIN (14/08/2019)

6.  Complete Left ICA
occlusion with incidental
A.com Aneurysm(5.3×
4.1mm)
 Good cross flow across
Acom A. filling left MCA
territory, some delay noted
in collateral flow

7. Complete Left ICA occlusion with
incidental A.com Aneurysm
Modified Rankin Scale (mRS)-5

8. Right Pterional Craniotomy
+
Clipping of A.com Aneurysm