2. INTRODUCTION
HEMORRHAGIC STROKE : It is rupture of blood
vessels in or on the surface of brain with bleeding
into surrounding tissues
RISK FACTORS :
• Age > 80yrs
• HTN
• Previous history of ischemic stroke
• AVM
• Coaugulopathy
• Aneuyrsm
3. CLASSIFICATION
• 3 types – sub- arachonoid
intra-cerebral
subdural hematoma
SYMPTOMS
Weakness in one side of body
Ataxia
Dysarthria
Vertigo
Asphasia
Syncope
Facial dropping
Photophobia
Pain in eye movement
4. PATHOPYSIOLOGY
Death
Decrease blood flow and platelet aggregation
Clot formation and elevates ICP
Further causes neurotoxicity of blood contents
Causes damage to surrounding tissue causing mechanical stress
Presence of blood or blood clots in brain parenchyma
Blood may enter through rupture of aneurysm
8. DEMOGRAPHIC DETIALS
• Name : ABC
• Age : 42yrs
• Gender : Male
• IP No : 461258
• Department:Neuroward
• DOA : 2/ Sept/
2019
• Height : 172cm
• Weight : 90kg
• BMI : 30kg/sqmm
9. CHIEF COMPLAINTS
• c/o right side body weakness
• slurring of speech
• Deviation of mouth
• Loss of consciousness
PRESENT HISTORY
• A 42yr old male patient presented with H/O right
side body weakness, slurring of speech, deviation
of mouth and loss of consciousness for further
management and treatment
10. PAST HISTORY :
• H/O Ischemic stroke
• S/P Thrombocytosis
• C-PAP
• Previously had seizures[5yrs back]
• HTN – Tab. Nicardia 20mg TID
12. DAY TO DAY ASSESMENT
DAY – 1
• c/o slurred speech
• Deviation of mouth
• Not using c-pap since
2days
DAY -2
• Patient conscious,
oriented
• slurred speech +
DAY – 3
• Following commands
• Normal vitals
• Physiotherapy
recommended
13. • DAY – 4
• Patient conscious/
coherent/ following
commands/ afebrile
• Vitals –normal
• Physiotherapy
recommended
DAY – 5
• Following commands
• Physiotherapy
continued
14. Physiotherapy Progress Notes
Day-3 [4/9/19]
• Limb physio done
• Spirometry
DAY -4 [5/9/19]
• AROM[Active Range Of
Motion]
• Spirometry
• Pelvic bridging
• Amputation
DAY-5 [6/9/19]
• AROM
• Co-ordination training
• spirometry
15. ICU COURSE TREATMENT
• Admission date – 2/9/19 Transfer date- 4/9/19
ICU Admission Diagnosis : Stroke – left capsuloganglionic bleed
• A 42 yr old male patient known case of HTN, old CVA [left
hemiporesis] presented with slurred speech, deviation of mouth,
loss of consciousness.
• Patient has history of thrombolysis 2014. Acc to MRI brain pt has
left capsuloganglionic bleed. Pt also has uretheral bleed and
hematuria.
• Inview of OSA and using c-pap pt referred pulmonology. Advised for
continuing BiPAP over night.
• In ICU patient was managed by antiiotics, anti-hypertensive, PPI’S,
nebulisation.
• Now patient is hemodynamically stable and shifted to neuroward
18. PARAMETER RESULT NORMAL VALUE
T.Bilirubin 6.56 0.5-1.1mg/dl
D.Bilirubin 0.00 0-0.35mg/dl
I.Bilirubin 0.40 0-0.65mg/dl
SGOT 26.00 6-38IU/L
ALP 46.00 36-142mmo/l
T.PROTIENS 7.60 6.8-3.3g/dl
A/G RATIO 1.20 Approx 1
Albumin 4.20 3.5-5.0g/dl
Gobulin 3.40 2-3.5g/dl
Blood urea 26 3-8mmol/L
Urea N2 1.81 2.5-7.1 mmol/L
19. Real time ultrasonography
• Urinary bladder is empty with foley bulb insitu
• Impression: no significant abnormality detected
Doppler study of carotid/vertebral
• Impression: no evidence of carotid artery
stenosis
MRI BRAIN
• Impression : STROKE –Left Capsuloganglionic
bleed
20. MEDICATION CHART
BRAND GENERIC DOSE ROA FREQ D-1 D-2 D-3 D-4 D-5 D-6
IVF NS Normal saline 1ooml IV Per hr + + + + + +
INJ.PAN Pantoprazole 4mg IV OD + + + + + +
INJ.ZOFER Ondansetron 40mg IV TID + + + + + +
INJ.OPTINE
URON
Vit B complex 3ml IV OD + + + + + +
INJ
NEOTROPIL
Piracetam 3g/15
ml
IV TID + + + + + +
TAB.ROUVA
S
Rosuvastatin 40mg PO HS + - - - - -
INJ
MAGNEX
FORTE
Cefaperazone
+ Salbactum
1.5g IV BD - - + + + +
21. BRAND GENERIC DOSE ROA FREQ D-1 D-2 D-3 D-4 D-5 D-6
SYP.DUPHLAC lactulose 30ml PO BD - - + + + +
NACL 0.9% Sodium
chloride
P/N TID - - + + + +
T.NICARDIA Nifedipine 20mg PO TID - - + + + +
OTRIVIN
NASAL
DROPS
Xylometazolin
e
TID - - + + + +
T.COLIHENZ Citicholine +
piracetam
800m
g
PO BD + + - - - -
25. ASSESSMENT
• Based on subjective and objective data the
patient was diagnosed with STROKE –
CAPSULOGANGLIONIC BLEED
26. PLANNING
GOALS OF TREATMENT
• Reduce the ongoing neurological injury
• Decrease mortality
• Decrease long term disability
• Prevent reoccurrence of stroke
• Prevent further complications secondary to
immbolity and neurological dysfunction
27. TREATMENT OPTIONS
INJ. NOOTROPIL
• MOA – It works by
improving blood flow and
oxygen to the brain
• Uses – cognitive enhancer,
stroke
• Side effects- wt gain,
weakness, stomach pain
• MP- LFT, RR
TAB. ROSUVAS
• MOA- competitive inhibitor
of HMG-COA reductase,
reducing choloesterol
synthesis
• USES- cvs diseases, high
cholesterol levels
• SE – joint pain, indigestion,
loose stools
• MP – Lipid profile ,
creatinine phosphodikinase
28. OTRIVIN NASAL DROPS
• MOA – works by shrinking
blood vessels in nasal
passage
• Uses - obstrutctive sleep
apnea, nasal congestion
• SE – Dry mouth, throat,
burning or stinging
sensation
• MP - BP
TAB. NICARDIA
• MOA –calcium channel
blocks an decreases BP
• USES – HTN
• SE- dizziness, flushing,
cough
• MP – BP, ECG, O2 saturation
29. Tab. COLIHENZ
• MOA- citicoline works by replenishing
necessary chemicals in brain & regulate
process of cognition & play vital role in neural
communication
• USES – Sroke
• SE –SOB, agitation and anxitey
• MP – bp, ECG, LFT
30. PROBLEMS IDENTIFIED
UNTREATED INDICATON
• Blood urea and urea
nitrogen levels are
abnormal but no drug is
given
• Total bilirubin level is also so
high but still it is not treated
UNINDIACTED MEDICATION
• SYP. DUPHLAC is given even
though no complaint of
constipation
34. PATIENT COUNSLLING
ABOUT THE DISEASE
• A stroke is a neurological illness
that occurs when blood flow to
brain is interrupted.
• Discuss stroke risk factors as this is
2nd attack of stroke
• Explained further complications of
stroke like cvs disease, seizures
etc..
35. ABOUT MEDICATIONS
• Do not withdraw suddenly the drugs cognitive
enhancers as the cause withdrawl symptoms
• Follow the medications as per the prescription
• Do not miss the dose
• Do not double the dose
• If any ADR seen report to physician
immediately
36. LIFESTYLE MODIFIACTIONS
• Begin an exercise program
• Limit the alcohol intake
• Avoid smoking
• Know your cholesterol level
• Learn stress management
• Avoid wearing tight dresses
37. DIET
Foods to avoid
• Reduce the amount of salt
• Reduce the amount of fat and choloesterol
• Limit vegetable oils and nut oils
• Limit sweets and processed foods such as chips ,
cookies & BAKED FOODS
• Do not eat trans foods
• Don’t eat any food that has hydrogenated listed
in its ingridients
38. • Foods to be taken
• Eating more fresh
vegetables and fresh fruits
• Eating more lean proteins,
such as fish, poultry
• Using low fat dairy
products
• Olive oil is recommended
• Avacados, flax seed ,
tomato, red wine can be
taken