A 70-year-old man with diabetes presented with slurred speech and altered behavior lasting 30 minutes. He was diagnosed with a transient ischemic attack caused by low blood sugar. Tests showed high HbA1c and cholesterol. An MRI showed age-related brain atrophy and ischemic lesions. He was admitted, prescribed medications including aspirin and antidiabetic drugs, and counseled on diet and blood sugar control to prevent future attacks.

1. A CASE STUDY ON TRANSIENT ISHEMIC
SHOCK
PRESENTED BY : UNDER THE GUIDELINES OF:
D.PRIYA CHANDANA RANAKISHORE
III PHARM.D
19AB1T0022
VIGNANA PHARMACY COLLEGE
(Approved by AICET , PCI – new delhi and affliated to JNTUK)
Vadlamudi, Guntur dist , Pin.code : 522213

2. INTRODUCTION OF TRANSIENT
ISCHEMIC ATTACK
• DEFINITION : A trans ient ischemic attack [ tia ] or mini strock is caused by
a temporary disruption in the blood supply to part of the brain . The
distruption in blood supply results in a lack of oxygen to the brain
• ETIOLOGY : smoking
high blood pressure
obesity
high cholestrol level
alcohol
diabeties
arterial fibrillation

3. PATHOPHYSIOLOGY : A TIA characterised by temporary reduction reduction of blood
flow in a neurovascular distribution as a result as a result of partial or total
occlusion – typically from a thromboembolic event or stenosis of vessels
• Clinical manifestation would depend on the cerebral territory involved
RISK FACTORS : HTN
DM
smoking
previous strock
previous tia
cardiac arrthymias
obesity
oral contaceptive pills
SIGNS AND SYMPTOMS : face – face droop /assymetry
arms – arms drift / arm weakness , numbness
specch – slurring of speech

4. • DIAGNOSIS : COMPLETE BLOOD COUNT
a fingerstick blood glucose for hypoglycemia
serum electrolyte levels
coagulation studies
ECG
MRI
carotid doppler ultrasonography of the neck
CT angiography
MRA
TREATMENT : ANTI PLATELET DRUGS
ANTI COAGULANTS
SURGERIES : ANGIOPLASTY

5. PATIENT DETAILS
• NAME : XXX
• AGE : 70 YRS
• SEX : MALE
• IP NO : IPGN221000184
• UMR NO : GN-221000412

6. SUBJECTIVE
• C/O : slurring of speech , altered behaviour
lasting for 30 min at around 2: 30 on 7-10-
22.light upper lower limb weakness no 4/0
headache seizures or loss of conciousness
jency moviements bowel and bladder
incontinence

7. OBJECTIVE
• Past medical history : Diabetes
• Past surgical history: nill
• Past trauma history : nill
• Social history : nill
• Family history : nill
• Surgeries : nill

8. VITALS
• B.p : 120/80 mm hg
• P.R : 87 / MIN
• H.R : 87 BPM
• R.R : 22/MIN
• SPO2: 98%
• TEMP:98.6F
• HEIGHT:178CM
• WEIGHT:95KG

9. LAB INVESTIGATIONS
HbA1C 7.7%
NONDIABETIC LEVEL 4.3 -
6.3%
DIABETIC CONTROL 6.4-
7.9%
POOR CONTROL 8.0 – 9.0
%
POST PRANDIAL BLOOD
SUGAR
189 MG / DL
NON DIABETIC 60-
140MG/DL
PRE DIABETIC 140-200
DIABETIC >200MG/DL

10. MRI
IMPRESSION :
• age related atrophic changes as described [
lose brain leiis [ neurons] and connections
increases between brain cells and brain vol
decreases]
• Periventricular ischemic with ischemic foci as
described [ ischemic in ventricules of brain]

11. BLOOD GAS ANALYSIS WITH
ELECTROLYTES
PH 7.415 7.350 – 7.450
PCO2 33.7MMHG 32.0 – 48.0
PO2 86.1MMHG 83.0 - 108
PCO3ACT 21.2
BE[ECF] -2.6
O2 SAT 95.1
LACTATE 1.6MMOL/L
IONISED CALCIUM 1.06MMOL/L 1.15 – 1.33

12. ECG
IMPRESSION :
• Sinus rhythum
• Low T wave
SERUM ELECTROLYTES:
SODIUM 143MMOL/L 137.0 – 145.0
POTASSIUM 4.3MMOL / L 3.5 – 5.1

13. RENAL FUNCTION TESTS
BLOOD UREA NITROGEN 17MG/DL 9 - 20
CREATININE 1.4MG/DL 0.7 – 1.2
RANDOM BLOOD SUGAR 86MG/DL 60 – 140MG/DL

14. LIPID PROFILE TEST
TOTAL CHOLESTROL 161 MG/DL HIGH >140MG/DL
DESIRABLE <200MG/DL
BOARDERLINE 20 - 239
TRIGLYCERIDES 191MG/DL NORMAL
<130,BORDERLINE 131 –
199, HIGH 200-499,VERY
HIGH 750
HDL CHOLESTROL 26MG/DL 40-60
NON HDL CHOLESTROL 135MG/DL 80-130
VLDL CHOLESTROL 34MG/DL 5-30
LDL CHOLESROL 101MG/DL 20-100
LDL CHOLESTROL/HDL
CHOLESTROL
4.0 0.4-0.8
TOTAL CHOLESTROL/HDL
RATIO
6.0 1-5

15. LIVER FUNCTION TESTS
TOTAL PROTEIN 8.3 G/DL 6.3 – 8.2
ALBUMIN 4.3G/DL 3.5 – 5.0
GLOBULIN 4.0GM/DL 1.5 – 3.0
A/G RATIO 1.0 1.5 – 3.0
TOTAL BILIRUBIN 0.5MG/DL 0.2 – 1.3
DIRECT BILERUBIN 0.2MG/DL 0.0 – 0.2
INDIRECT BILIRUBIN 0.3MG/DL 0.2 – 0.8
SGOT/AST 19 U/L 17-59
SGPT/ALT 13U/L 21-72
ALKALINE PHOSPHATASE 69U/L 38-126

16. COMPLETE BLOOD COUNT
HB 11.2 G/DL 12.0-15.0
TOTAL WBC COUNT 9,400CELLS/CUMM 9000-11000
TOTAL RBC COUNT 4.06MILLON/CUMM 4.8-8.8
PLATELET COUNT 2.70LAKHS/CUMM 1.5-4.0
PCV 34.1 % 37-49
MCH 27.6PG 27-32
MCHC 32.9% 31.5-34.5
MCV 84FL 83-101
ABSOLUTE LYMPHOCYTE
COUNT
2890 1000-3000
NEUTROPHILLS
LYMPHOCYTE RATIO
2.0 0.78-3.5

17. NEUTROPHILS 60% 55-70
LYMPHOCYTES 31% 25-40
EOSINOPHILS 03% 1-8
MONOCYTES 06% 1-10
BASOPHILS 00% 0-1

18. ASSESMENT
• A 70 years old male patient known case of
diabetic normotensive came to hospital with
c/o slurring of speech altered behaviour
lasting for 30 min at around 2:30 on 7/10/22
with blood sugar levels 69mg / dl was
dignosed with transient ischemic attack
,neuroglycopenia

19. PLAN
• Hospitalisation
• Mri brain
• Monitoring blood sugar
• Salt restricted diabetic diet
• Avoid hypo/hyperglycemia

20. DRUG DOSE ROA FREQUENCY
INJ PANTOP 40MG IV OD
INJ OPTINEURON 1AMP IV OD
TAB.PANTOP 40MG P/O OD
TAB.ROSUVAS 40MG P/O HS
TAB.ASPRIN 75MG P/O OD
TAB.CLOPITAB CV 75MG/20MG P/O OD
SYP CREMAFFIN 75ML P/O OD
TAB GLYCOMET GP4
FORTE
4/1000MG P/O BID
TAB NEX CD3 50/500MG P/O OD
REJUNEX CD3 1 PO OD