ACUTE CVA WITH RT FACIO BRANCHIAL PALSY. Onset: < 03 hours

1. CASE PRESENTATION ON
ACUTE CVA WITH RT FACIO
BRANCHIAL PALSY
PRESENTED BY:
MAHARSHI MALLELA
Y16PHD0815

2. • Patient’s Name: V
• Sex: MALE
• Age: 66 yrs
• Height: 160cm
• Weight: 54kg
• Physician: DR.C.
• Patient ID: I4000018756
• Date of Admission: XX-XX-XXXX
DEMOGRAPHIC DETAILS

3. SUBJECTIVE EVIDENCE
• C/O deviation of angle of mouth and tongue to
left side from 3hrs (up to 2hrs)
• C/O slurred speech
• Ex-smoker.
PMx:
• K/C/O Hypertension sine 8yrs
Rx: Tab. Telmisartan 40mg/OD

4. OBJECTIVE EVIDENCE
VITALS:
• Temp: 98.6F
• RR: 20/min
• PR: 108/min
• BP: 130/80 mm Hg
• P/A: soft
• CVS: S1,S2+
• CNS: Normal
• GCS: E4 V5 M6
ABNORMAL
BIOCHEMICAL TESTS:
1. WBC: 13500* ↑ (4400-
11000)
2. HB: 11.8* ↓ (14-18)
3. PCV: 37* ↓ (42-54)
4. MCHC: 31.8* ↓ (32-37)
5. RDW: 17.2* ↑ (11.6-14)

5. DIAGNOSTIC PROCEDURES:
 2D-ECHO:
IMP: * LVEF 45%
* CAD
* mild LV dysfunction
*G-I diastolic dysfunction
* 2.9 x 1.6 cm LV apical clot (+)
* Trival MR, TR
 ECG: abnormal
IMP: * SINUS TACHYCARDIA
* ST and T wave abnormality- lateral ischemia
 CAROTID COLOUR DOPPLER STUDY:
IMP: * B/L Intima Media thickening noted (rt- 0.13cm, lt- 0.16cm)
* Focal calcified plaque in lt carotid bulb extending in lt proximal internal
carotid artery. 4x3mm causing 10-20% area stenosis.
 MRI- BRAIN:
IMP: *NO acute infract
? ischemia

6. ASSESSMENT
CAUSES:
 Age
 Hypertension
 Cigarette smoking
RISK FACTORS:
• Gender, Race, Family history of stroke, Low birth weight
• Atrial fibrillation, Diabetes, Dyslipidemia, Alcohol, Sickle cell
disease, Obesity, Physical inactivity and Diet
COMPLICATIONS:
 Cerebral oedema
 Seizures
 Cardiogenic shock
 Pulmonary embolism, DVT

7. PLANNING
DRUG CHART:
DRUG NAME DOSE ROA FRQ INDICATION CATEGORY
1. Inj. CLEXANE
(Enoxaparin)
60mg
(6000IU)
S/C BD Prophylactic for
DVT
Anti coagulant-low
molecular weight
heparins
2. Tab. Atorvastatin 40mg P/O OD For lowering lipid
levels (LDL)
HMG CoA reductase
inhibitors or statins
3. Inj. EDASTAR
(Edaravone)
30mg I/V BD For oxidative stress Antioxidants
4. Inj. PANTOCID
(Pantoprazole)
40mg I/V OD Prophylactic use Proton pump
inhibitors (PPIs)
5. Tab. TAZLOC
(Telmisartan)
40mg P/O OD For high blood
pressure
Angiotensin receptor
blockers (ARBs)
6. Tab. RESTYL
(Alprazolam)
0.25mg P/O H/S For anxiety or panic Benzodiazepines
7. Tab. CLOPILET
(Clopidogrel)
75mg P/O BD For stroke Antiplatelets

8. STANDARD TREATMENT
• Must quickly restore blood flow to the brain
• Emergency treatment:
Tissue plasminogen activator (tPA)- Alteplase
Initial dose: 0.9mg/kg IV bolus over 1hour
Following dose: 0.81mg/kg cont. infusion over 60min
• Antiplate agents and anticoagulants with in 24hrs if alteplase is
not recommended
Aspirin 160-325mg oral with in 48hrs followed by 75-100mg daily
Clopidogrel 75mg oral OD
Combination of aspirin and clopidogrel with in 24hrs upto 21 days
Heparin 70-100units/kg IV bolus
• Medications delivered directly to the brain (catheter)
• Carotid endarterectomy
• Angioplasty and stents

9. LIFE STYLE MODIFICATIONS