This case presentation summarizes a 36-year-old male admitted with acute ischemic stroke presenting with right hemiparesis and reduced vision in the right eye. Diagnostic workup including CT scan revealed an acute infarct in the left occipito-parietal region. He was diagnosed with acute ischemic stroke and treated with medications including aspirin, clopidogrel, atorvastatin, and mannitol. His symptoms improved over his hospital stay and he was discharged on aspirin and clopidogrel with counseling on medication adherence and lifestyle modifications to prevent further complications.
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Acute Ischemic Stroke Case Presentation
1. CASE PRESENTATION ON
Acute Ischemic Stroke With
Right Hemiparesis.
Presented by,
Md Masiuddin
H.T. no : 15ED1T0015,
Pharm-D IV year.
2. DEMOGRAPHIC DETAILS:
NAME : XXX
AGE : 36years&3months
SEX : Male
ADDRESS : Warangal
IP NO : 13927
DOCTOR : Dr.Rajeev Rajan
3. REASONS FOR ADMISSION :
Sudden onset of Reduced Vision In the Right Eye,since 1 day.
Associated with Pain in Both Temporal Regions of Head.
Weakness of Left Upper and Lower Limbs,since 1 day.
4. PAST MEDICAL HISTORY :
Nill
FAMILY HISTORY : Nothing significant
SOCIAL HISTORY : Mixed diet,
alcoholic,
Non smoker.
22. SUBJECTIVE EVIDENCE
Sudden onset of Reduced Vision In the Right Eye,since 1 day.
Associated with Pain in Both Temporal Regions of Head.
Weakness of Left Upper and Lower Limbs,since 1 day.
23. OBJECTIVE EVIDENCES
Pallor :+ve Hb : 13.9gm%
RBC : 5.5 m/cmm RBC : Normocytic
CT SCAN : Acute infarct Noted in Left occipito Parietal
Region in Parafalcine location
24. ASSESSMENT
Diagnosis : Based on the subjective and objective evidences the
diagnosis was made to be Acute Ischaemic Stroke with Right
Hemiparesis.
Etiology : Mixed diet,
caused by a Blocked Blood Vessel in the Brain.
Assessment if therapy is indicated : Yes therapy for this
patient is absolutely essential to prevent further complications.
25. Standard therapy
Category Drug Max.Dose
ANTI
CONVULSANTS
PHENYTOIN
LEVETIRACETA
M
10-20 or 1-2
mcg/L
500mg iv
every 12hrs
BETA
BLOCKERS
LABETOLOL 200-400mg
PO BID
Anti platelet Aspirin 150 mg po OD
Diuretics Mannitol 1.5-2gm/Kg
for 30-60mins
26. ASSESSMENT OF CURRENT THERAPY
DRUG DOSE FREQ ROA
INJ.PANTOPRAZOLE 40mg OD IV
INJ.MANNITOL 100ml TID IV
TAB ASPIRIN 150mg OD PO
TAB CLOPIDOGREL 75mg OD PO
TAB ATORVASTATIN 20mg OD Po
27. INJ.PANTOPRAZOLE :
CATEGORY : Proton pump inhibitor
INDICATION : it is indicated to decrease acid production.
DOSE : 40mg OD
SIDE EFFECTS : Headache,Facial edema,Chest pain,
Diarrhea.
28. Tab.Aspirin
CATEGORY : NSAID,Anti Pyretic,Anti Platelet.
INDICATION : It is used to treat or Prevent Heart attacks,
Stroke and Chest pain.
DOSE : 150mg once daily.
SIDE EFFECTS : Hepatotoxicity,Trachycardia, Hypotension,
Chest pain.
29. INJ.MANNITOL
CATEGORY : Osmotic diuretic.
INDICATION : it is used to reduce Swelling and pressure
inside the eye or around brain.
DOSE : 1.5-2gms/kg/IV/
SIDE EFFECTS : hyponatremia, hypokalemia, hypochloremia,
hypovolemia.
30. Tab.Clopidogrel
CATEGORY : Anti platelet agent.
INDICATION : It is used to lower your risk of having a stroke,
blood clot, or serious heart attack.
DOSE : 75mg once daily.
SIDE EFFECTS :chest pain,Head ache, arthralgia.
31. Tab.Atorvastatin
CATEGORY : lipid lowering agents.
INDICATION : It is used to treat high cholesterol and to
lower the risk of Stroke,heart attack etc.
Dose : 20mg po once daily.
Side effects : Diarrhea, Nasopharyngitis,arthralgia.
34. GOALS OF TREATMENT
GENERAL GOALS :
To reduce morbidity and mortality,
To improve quality of life,
To prevent and treat complications
PATIENT SPECIFIC GOALS :
To decrease signs and symptoms like reduced vision
To Avoid Complications of delirium and seizures
35. PATIENT CONSELLING :
ABOUT THE DISEASE :
Disease is in Acute stage.
Medication adherence is very important.
Missed dose should be taken within 45 mins,If not it should
not be taken, Double dose should not be taken at a time.
ABOUT THE DRUGS :
Tab.Atorvastatin : Taken once daily after food at night time
36. LIFE STYLE MODIFICATIONS :
Avoid Alcohol Consumption and smoking.
Be physically Active.
Decrease your stress level and Maintain a healthy weight.
Avoid foods like egg yolks,fatty meals,butter,cream which are
high in Fat and cholesterol.
Eat Moderate amount of food and cut down on saturated fat,
sugar and salt.
Eat fruits, vegetables, whole grains, and fat-free or low-fat
dairy foods. Whole grains include whole-wheat breads,
cereals, pasta, and brown rice.
Do not eat right before bedtime.