1) A 65-year-old male patient presented with symptoms of slurred speech, right-sided weakness and facial droop for 2 days. He had a history of hypertension and smoked cigarettes and consumed alcohol regularly. 2) Examination found right-sided hemiplegia and hemaparesis. Imaging showed a moderate hypo-dense lesion in the ganglion area consistent with an ischemic stroke. 3) He was diagnosed with ischemic stroke and treated with medications to reduce blood pressure and cholesterol, prevent clots, and manage symptoms. Physiotherapy was also advised. His symptoms gradually improved over his hospital stay.

1. CASE PRESENTATION
Stroke
By-Nagaraju B

2. Patient Name -xxx
IP/OP No -309/13
DOA - 1/4/13
DOD - 5/4/13
Department - Med
Unit -II
Age - 65years
Sex - Male
Weight -87kgs

3. SUBJECTIVE
Chief complaint/ History of Presenting illness:
Patient c/o slurring of speech, confusion x 2 days
weakness of right side since 1 day
deviation of angle of mouth
Previous history:
k/c/o Hypertension x 6 years
(Atenolol 50mg 1-0-0)
Smokes 20 cigarettes/day x 20 years and
consumes 6 ounces wine/day x 25 years
PastMedicationHistory/Allergy:
Nothing significant

4. Personal history:
Diet- Mixed
Appetite-Normal
Sleep-Slightly decreased
Bowel –Constipation+
Bladder- Regular
Habits- Smoking, Alcoholism
Physical examination : patient was conscious but not
responding to oral commands
power: right upper limb - 2/5 & lower limb - 3/5
Vital signs:
BP - 180/90mmHg PR – 60bpm
RR – 18cpm Temp – afebrile
Family history:
no f/h/o DM, HTN, Asthma, TB,
Stroke, Epilepsy
OBJECTIVE

5. P[-], I[-], C[-], C[-], L[-], E[-]
Systems :
P/A - soft, non tender
RS - NVBS+, no additional sounds.
CVS – S1S2+, no murmurs
CNS – Motor Loss-Hemiplegia, Hemiparesis
Provisional diagnosis :
? stroke

6. TEST TEST VALUE NORMAL VALUE
Hb (g/dl) 15.6 gm% 13-18
Total leucocytes counts
(cells/cmm)
6000 4000-11000
N (%) 75% 40-75
L (%) 22% 20-45
E (%) 03% 1-6
M (%) 00% 2-10
B (%) 00% 0-1
Platelets (cells/cmm) 3Lac 1.5-4.0 lakh/cmm
ESR 10 0-17 mmhr
Urine Routine Sugar: Nil Albumin: Traces
Urine Microscopy Pc: 1-2 Ep: 1-2 cells
LABORATORY INVESTIGATIONS

7. TEST TEST VALUE NORMAL VALUE
Sr. Cr (mg/dl) 1.1 0.2-1.4mg/dl
GRBS 70 70-160mg/dl
Ser. Cl- 102 Up to 103 mEq/L
Ser. Na+ 136 136-145mmol/L
Ser. K+ 3.8 3.5-5.1 mmol/L
Total-C: 201 130-200mg/dl
HDL-C: 34 30-70mg/dl
LDL-C: 167 60-130mg/dl
VLDL: 24 5 – 40mg/dl
TG : 151 25- 160mg/dl
ECG ST segment elevation
CT-Scan Moderate sized, well defined hypo dense lesion in
ganglion area

8. ASSESMENT
Based on the subjective & objective evidence the
patient was diagnosed to have ischemic stroke.

9. BRAND NAME GENEROIC NAME DOSE FREQU
ENCY
DATE DATE END
Kratol Inj mannitol 20%
IV
100ml 1-1-1 1/4 4/4
Aten-50 Tab. Atenolol 50mg 1-0-0 1/4 Cont-
Stromix-A Tab.Clopidogrel
+Aspirin
75/150mg 0-1-0 1/4 Cont-
Cholechek-10 T.Atorvastatin 10mg 0-0-1 1/4 Cont-
Nexpro-20 T.Esomeprazole
magnesium
20mg 1-0-0 1/4 For 4 wk
Inj.Neurocetam Inj. Piracetam 200mg 2-2-1 1/4 4/4
Inj Nitroject Inj.
Nitroglycerine
5mcg/min
IV
1-2-2 1/4 4/4
Angispan-TR T.Nitroglycerin 6.5mg 1-0-1 5/4 For 4 wk
Piramet1200 T.Piracetam 1200mg 1-0-1 5/4 For 4 wk
MEDICATION CHART

10. DAY 1
BP : 180/90 mmHg
PR: 60bpm
O/E : Patient was conscious but not
responding to oral commands
power: right upper limb - 2/5
lower limb - 3/5
Others: ECG: ST segment elevation
ADV: Hb, TC, DC, PLT, RBS, SERUM
Cr, UREA, ELECTROLITE,URINE ®, LIPID
PROFILE, CT- SCAN

11. DAY 2
PULSE: 65 bpm
BP: 160/90mmhg
O/E: Patient was conscious and
was responding to oral commands.
Advised to continue same
treatment referred to
physiotherapist

12. DAY 3
BP: 170/90
PULSE : 75bpm
Adv: Advised to continue the medication
as such

13. DAY 4
BP:160/76mmHg
PULSE : 80bpm
O/E ; Patient feels better
Power: 3/5 (UL)
4/5 (LL)
Adv: Patient was advised to cst

14. DAY 5
BP: 140/90mmHg
PULSE: 70bpm
Adv: CST

15. Suggestion to Physician-
No drug interaction is found.
PLAN

16. Advice to patient-
 Avoiding smoking
 Cutting down fat and cholesterol containing foods to
help reduce plaque build up
 Eating a healthy diet including plenty of fruits and
vegetables
 Limiting sodium in the diet, thereby reducing blood
pressure
 Exercising regularly
 Having 3 cup of green tea/ day
 Moderating alcohol intake
 Maintaining a normal weight
 Controlling blood pressure and keeping blood
sugars under control

17. THANK YOU…