OCT and OCTA in DR practical discussions

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KafrELShiekh University

OCT and OCTA in DR practical discussion

Health & Medicine

OCT & OCTA
in DR …
A Practical Discussion
Mohamed ELShafie, MD
Lecturer of ophthalmology
Kafr ELShiekh university

OCT and OCTA in DR practical discussions

Acute Limb Weakness case presentation PBL session 3rd year neuro ophthalmology new mansoura university A 54-year-old man, Mr. Stephen Smith, was brought by ambulance to the ‎Emergency Department. He had woken up from sleep with slurring of speech ‎and weakness of his right arm and leg. His wife was extremely distressed as Mr ‎Smith had been perfectly well the previous night when he went to sleep. Within ‎‎20 minutes after the initial call was made Mr. Smith was admitted to the ‎Emergency Department and was reviewed by the SpR covering the Regional ‎Specialist Stroke Unit. Mr. Smith had been on regular antihypertensive ‎medication (lisinopril) for 8 years. He smoked 5-8 cigarettes a day and was a ‎social drinker consuming about 6 units of alcohol a week. He was not diabetic. ‎ His Serum lipids were checked and was advised to reduce weight and ‎started on a Statin (Simvastatin). There was no family history of hyperlipidaemia ‎but his grandfather died after a Stroke. Mr. Smith had an urgent appendectomy 1 ‎week and made an uneventful recovery. He lives with his wife in a 4-bedroom ‎detached house. ‎ Neurological examination showed that Mr. Smith was fully conscious and ‎alert. He had an upper motor neuron facial palsy on the right side. He had ‎expressive dysphasia but appeared to comprehend speech. He was just able to lift ‎his right arm off the bed for a short period but had no grip. His right leg was ‎weak. ‎ Reflexes on the right side were exaggerated and his right plantar was ‎extensor. He responded to touch and pin prick equally on both sides. He either ‎had visual inattention or a visual field defect on the right side. He had no ‎papilloedema His blood pressure was 164/96, pulse 84 per min, regular. Other ‎systems were entirely normal. ‎ ECG and all routine blood tests were performed. An emergency CT scan ‎was requested and even though the scan was normal the SpR ruled out ‎emergency thrombolysis in this instance. Mr. Smith was admitted to the Acute ‎Stroke Unit and was seen by the Stroke Consultant. Mr. Smith remained fully ‎conscious and alert but had some difficulty in swallowing. Hence an intravenous ‎infusion was commenced and an alternate strategy was adopted for providing his ‎nutritional requirements. A carotid Doppler scan was requested. ‎ After 3 weeks, Mr. Smith seemed to make good progress and the MDT ‎meeting recorded a consistent improvement in his Barthel Index. The Stroke ‎Team met him with his wife and discussed arrangements for discharge home. His ‎wife was keen to know what support measures were available to them when Mr. ‎Smith returned home. She also wanted to know about the risk of a future stroke ‎and how this could be cut down. ‎ ILOs:- ‎ ‎1- Consider the differential diagnosis of speech. ‎ ‎2- Discuss the risk factors for stroke and primary prevention of stroke. ‎ ‎3- Discuss the overall management of a patient with an acute stroke. ‎ ‎4- Complications of stroke

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