Case Studies Prepared By Arlyn M. Valencia, M.D. Associate Professor University Of Nevada School Of Medicine
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The document describes several case studies of patients presenting with symptoms of stroke: 1) A 60-year-old man with a history of hypertension and recent myocardial infarction presented with sudden Broca's aphasia, right central facial paralysis, and right arm weakness indicating a left middle cerebral artery branch infarct. 2) A 70-year-old woman with a history of hypertension, diabetes, and non-compliance with medications presented with global aphasia, left gaze deviation, right-sided weakness and sensory loss indicating a left anterior cerebral artery infarct. 3) A 36-year-old man with a history of deep vein thrombosis became lethargic with right gaze deviation, left hemip
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1. A 70-year-old woman presented with headaches, weakness, and vision issues. MRI showed lesions in the parieto-occipital junction consistent with posterior reversible encephalopathy syndrome (PRES).
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2. Autopsy of a 47-year-old woman found dead at home identified a subarachnoid hemorrhage concentrated at the brain base from a ruptured cerebral aneurysm.
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1. Stroke is the sudden onset of neurological deficit due to vascular infarction of brain tissue, confirmed by neuroimaging. The two main types are ischemic (80%) and hemorrhagic (20%).
2. Risk factors for ischemic stroke include atherosclerosis, atrial fibrillation, smoking, hypertension, diabetes, and heart disease. Evaluation includes CT, MRI, ECG, and NIH stroke scale.
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Left to right shunts occur when blood flows from the left side of the heart to the right side due to defects, resulting in less blood circulating through the body but the blood remains oxygenated. Eisenmenger's syndrome is a reversal of this shunt into a right to left shunt due to chronic defects causing pulmonary hypertension and increased right heart pressure. Common cyanotic and acyanotic congenital heart defects are described along with their associations, presentations, examinations, and management approaches. A number of genetic syndromes associated with increased risk of certain heart defects are also detailed.
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A 62-year-old man presented with sudden onset of unsteadiness, tendency to fall to the right side, loss of sensation in the right half of the face and left side of the torso, and dysphagia. On examination, he had partial ptosis, enophthalmos, miosis of the right eye, and cerebellar signs. Localizing the lesion based on associated neurological deficits suggests a lesion in the pons, as the patient has crossed sensory loss of the face indicative of a lower motor neuron lesion of the trigeminal nerve, as well as unilateral facial numbness and potential unilateral deafness. Lesions in specific areas of the brainstem can be localized based on the cranial nerves
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APPROACH TO A PATIENT PRESENTING WITH LIMB WEAKNESS
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Stroke as the first manifestation of Takayasu's arteritis
Stroke as the first manifestation of Takayasu's arteritis
Case Studies Prepared By Arlyn M. Valencia, M.D. Associate Professor University Of Nevada School Of Medicine
- 2. 60year-old right handed WM with h/o HTN (hypertension), recent MI (myocardial infarction)who had sudden-onset Broca’s aphasia (mute), right central facial paralysis, right pronator drift
- 3. Left Middle Cerebral Artery Branch Infarct (Stroke) (Note: Not the entire territory of MCA Is involved; the stroke is pie-shaped and involves both gray & white matter) Probable etiology: with the history of MI, cardioembolic.
- 4. More clearly defined infarct, frontal lobe
- 5. 70 year-old right handed WF, smoker, has h/o HTN, DM (diabetes mellitus), non- compliant with meds. PE: left carotid bruit; edema on right arm NE: awake, alert, with global aphasia, left gaze deviation, no response to visual threat presented on right visual field; right hemiparesis (RUE plegic, RLE 3/5 long-tract pattern of weakness), impaired sensation on the right side
- 7. 70 year-old WM who had new-onset right-sided weakness, leg weaker than arm, abulia (lack of spontaneity)
- 8. Left Anterior Cerebral Artery Infarct (ACA)
- 9. Left Anterior Cerebral Artery (ACA) Infacrt
- 10. 69 year-old right-handed BM, brought in by wife who found patient on floor. When asked, patient’s only complaint was headache. Examination revealed an awake, alert patient with anosognosia; left hemineglect; right gaze preference, inattention to left field; extinction to double simultaneous stimulation (visual and sensory) ; left hemiparesis, arm weaker than leg, left hemisensory deficits
- 11. Right Middle Cerebral Artery (MCA) Territory Infarct ) Full MCA Stroke
- 12. 36 year-old right handed, with h/o previous DVT’s (deep venous thrombosis), lethargic, right gaze deviation, left hemiplegia, hemisensory, later became comatose with decerebrate posturing, anisocoria (right pupil >left)