Case Presentation On Cerebrovascular Accident With Ischemic Stroke

1. CASE PRESENTATION ON
CEREBRONROVASCUALAR ACCIDENT
WITH ISCHEMIC STROKE
Presented by :
METI.BHARATH KUMAR
16DK1T0014
Pharm-D(Intern)

2. DEMOGRAPHIC DETAILS
• NAME: xyz
• AGE:47 years
• GENDER:male
• DEPARTMENT: General medicine
• UNIT:mm-7
• DOA:26/1/2022
• CONSULTANT PHYSICIAN:Dr.M.Maheswar Reddy M.D

3. SUBJECTIVE EVIDENCE
• A 47 years old male patient was admitted in the male medical ward
unit-7 with the chief complaints of ,
weakness of left upper and lower limbs since 1 week
slurring of speech since 1 week
nasal regurgitation since 1 week
• PAST HISTORY: diabetes and hypertension

4. OBJECTIVE EVIDENCE
CT BRAIN :
1.Acute infarct in right fronto parieto temporal occipital lobe.
2.Chronic small vessel ischemic changes.
3.Age related cerebral atrophy.
LIPID PROFILE:
Cholestrol: 198
Triglycerides: 128
HDL : 42
LDL :130
VLDL:26

5. OBJECTIVE EVIDENCE
Complete blood picture:
HGB: 12.0
WBC: 13.4
Rbc: 4.38
Plt: 260
RBS: 190mg/dl
Blood urea:19
Serum creatinine:0.5
Total bilirubin: 0.7
Direct bilirubin: 0.2
SGOT: 25
SGPT:14
ALP: 189

6. ASSESSMENT
• Based on the subjective and objective evidence the case is confirmed
as “ CVA WITH ISCHEMIC STROKE”.

7. PLAN OF TREATMENT
MONITOR VITALS DAY 1
• O/E pt is c/c
• Temp: afebrile
• PR:86 bpm
• RR:18 min
• Spo2:99% at RA
• P/A: soft
• BP: 150/90 mm hg
• Pupils: b/L NS r/L
• Plantor : R
L
• FBS: 197 mg/dl
Rx
• 1.inj.mannitol 100 ml IV TID
• 2.inj.ceftriaxone 1 g IV BD
• 3.inj.pantop 40 mg iv OD
• 4.tab.ecospirin 150 mg OD
• 5.tab.atorvas 40 mg h/s OD
• 6.inj.citicholine 1 amp in 100 ml NS
IV OD
• 7.tab.bcomplex/ca+2/vit d3 OD
• 8.inj.H.actrapid s/c TID 6 units
• 9.tab.clopitab 75 mg p/o OD

8. PLAN OF TREATMENT
MONITOR VITALS DAY 2
• O/E pt is c/c
• Temp: afebrile
• PR:86 bpm
• RR:18 min
• Spo2:99% at RA
• P/A: soft
• BP: 150/90 mm hg
• Pupils: b/L NS r/L
• FBS: 197 mg/dl
Rx
• 1.inj.mannitol 100 ml IV TID
• 2.inj.ceftriaxone 1 g IV BD
• 3.inj.pantop 40 mg iv OD
• 4.tab.ecospirin 150 mg OD
• 5.tab.atorvas 40 mg h/s OD
• 6.inj.citicholine 1 amp in 100 ml NS
IV OD
• 7.tab.bcomplex/ca+2/vit d3 OD
• 8.inj.H.actrapid s/c TID 6 units
• 9.tab.clopitab 75 mg p/o OD

9. DRUG CHART
S.NO GENERIC NAME BRAND NAME INDICATION DOSE ROA FREQUENCY
1 Mannitol Decrease
intracranial
pressure
100 ml IV TID
2 Ceftriaxone Reduce
infection
1 g IV BD
3 Pantoprazole Pantop Reduce acidity 40 mg IV OD
4 Aspirin Ecospirin Anti platelet
action
150 mg PO OD
5 Atorvastatin Atoravs Decrease
cholesterol
40 mg PO OD
6 Citicholine Citicam Recovery from
stroke
1 amp IV OD
7 Clopidrogel clopitab Anti platlet
action
75 mg PO OD
8 Human actrapid
insulin
Decrease blood
glucose levels
6 units S/C TID

10. PHARMACEUTICAL CARE ISSUES
• No pharmaceutical care issues found the prescription was rational.

11. DISCUSSION
Cerebrovascular accident (CVA) is the medical term for a stroke. A
stroke is when blood flow to a part of your brain is stopped either by a
blockage or the rupture of a blood vessel.
TYPES:
ISCHEMIC STROKE: occurs when a blood clot blocks a blood vessel
and prevents blood and oxygen from getting to a part of the brain.
HEMORRHAGIC STROKE:A hemorrhagic stroke occurs when a
blood vessel ruptures, or hemorrhages, and then prevents blood from
getting to part of the brain.

12. CLINICAL MANIFESTATIONS
• difficulty walking
• dizziness
• loss of balance and coordination
• difficulty speaking or understanding others who are speaking
• numbness or paralysis in the face, leg, or arm, most likely on just one
side of the body
• blurred or darkened vision
• a sudden headache, especially when accompanied by nausea,
vomiting, or dizziness

13. • Once symptoms start, it’s crucial to get treatment as quickly as
possible. This makes it less likely that damage becomes permanent. If
you think someone is having a stroke, evaluate them using FAST:
• Face. Is one side of their face drooping and hard to move?
• Arms. If they raise their arms, does one arm drift downward, or do
they have significant difficulty raising their arm?
• Speech. Is their speech slurred or otherwise strange
• Time. If the answer to any of these questions is yes, it’s time to call
your local emergency services.
•

14. Causes
• Ischemic stroke occurs when an artery that supplies blood to the
brain is blocked by a blood clot or fatty buildup, called plaque. This
blockage can appear at the neck or in the skull.
• Clots usually start in the heart and travel through the circulatory
system. A clot can break up on its own or become lodged in an artery.
When it blocks a brain artery, the brain doesn’t get enough blood or
oxygen, and cells start to die.
• Ischemic stroke caused by a fatty buildup happens when plaque
breaks off from an artery and travels to the brain. Plaque can also
build up in the arteries that supply blood to the brain and narrow
those arteries enough to cause ischemic stroke.

15. • Circulatory conditions are the main risk factor for ischemic stroke. That’s
because they increase your risk for clots or fatty deposits. These conditions
include:
• high blood pressure
• atherosclerosis
• high cholesterol
• atrial fibrillation
• prior heart attack
• sickle cell anemia
• clotting disorders
• congenital heart defects
Risk factors

16. • Other risk factors include:
• diabetes
• smoking
• being overweight, especially if you have a lot of abdominal fat
• heavy alcohol misuse
• use of certain drugs, such as cocaine or methamphetamines
• Ischemic stroke is also more common in people who have a family
history of stroke or who’ve had past strokes. Men are more likely than
women to have ischemic stroke, while blacks have a higher risk than
other races or ethnic groups. Risk also increases with age.

17. Diagnosis
A doctor can usually use a physical exam and family history to diagnose ischemic
stroke. Based on your symptoms, they can also get an idea of where the blockage
is located.
• If you have symptoms such as confusion and slurred speech, your doctor might
perform a blood sugar test. That’s because confusion and slurred speech are also
symptoms of severe low blood sugar.
• A cranial CT scan can also help distinguish ischemic stroke from other issues that
cause brain tissue death, such as a hemorrhage or a brain tumor.
• Once your doctor has diagnosed ischemic stroke, they’ll try to figure out when it
started and what the root cause is. An MRI is the best way determine when the
ischemic stroke started. Tests used to determine a root cause might include:
• an electrocardiogram (ECG or EKG) to test for abnormal heart rhythms
• echocardiography to check your heart for clots or abnormalities
• an angiography to see which arteries are blocked and how severe the blockage is
• blood tests for cholesterol and clotting problems

18. Management

19. PREVENTION AND COUNSELLING
• Maintain normal blood pressure.
• Limit saturated fat and cholesterol intake.
• Refrain from smoking, and drink alcohol in moderation.
• Control diabetes.
• Maintain a healthy weight.
• Get regular exercise.
• Eat a diet rich in vegetables and fruits.