OSCE AND LEARNING POINTS: HEMIPLEGIA

 1. Therapeutic window for stroke :

Current guidelines for the management of patients with acute ischemic stroke published by the American Heart Association Stroke Council include specific recommendations for the administration of intravenous recombinant tissue plasminogen activator (rtPA).

rtPA should be administered to eligible patients who can be treated in the  time period of 3 to 4.5  hours after stroke. (Evedenced by A recent prospective study, the European Cooperative Acute Stroke Study has provided new data on rtPA (alteplase) treatment in the 3-to-4.5–hour window).


2. Fibrinolytic therapy

Thrombolytic medications are delivered to the blood clot through an IV line or a catheter placed in your vein.

The thrombolytic therapy drugs in use today are:

- Alteplase.

- Reteplase.

- Tenecteplase.

anticoagulants such as warfarin or heparin to reduce the risk of future blood clots are also given.


3. Frontal lobe function tests :

Tests for frontal lobe function include working memory ( digit span, spelling backward), judgement,fund of knowledge,task organisation and set generation such as naming lists of things in a certain category.

4. Parietal lobe function tests :

These can be tested rapidly at the bedside with tests such as visual attention, construction all apraxia ( visuoconstructive deficits) and limb apraxia.

5. UMN LESION.

- Pyramidal & Extra-Pyramidal descending tracts are involved.

- conditions-Occurs in vascular accidents & space occupying lesions.

- Nutrition-Group of muscles affected

- tone-Increased

- power-No loss of power.

- reflexes : superficial and deep exaggerated

- babinski sign : positive

- clonus : present

- paralysis: spastic

- clasp knife reflex: present 


6. LMN LESION

- a and v motor neurons of spinal cord and of cranial nerve nuclei are involved

- Conditions-Occurs in poliomyelitis

- Nutrition - Single muscles are affected..

- Tone-lost

- Power-Lost

- reflexes - Superficial & deep Reflexes - Lost

- Babinski's sign- Negative

- Clonus-Absent

- Paralysis-Flaccid.

- Clasp Knife Reflex- Absent.


7.cushings triad 

Set of signs that are Indicative of raised ICP

cushing's triad : 1.bradycardia

                              2.irregualar respirations

                              3. Widened pulse pressure


8. Motor homunculus : 

 The motor homunculus is a topographic representation of body parts and it's correspondents along the precentral gyrus of frontal lobe




LEARNING POINTS: 

1. I learnt that outcomes ( less brain damage) and mortality are better in patients who recieve rTPA as soon as possible after stroke symptom onset ( more preferably within 3 to 4.5 hours of onset of symptoms)

2. sudden onset of weakness or neurological deficit suggests - CEREBRO VASCULAR ACCIDENT


3.how to determine whether it is embolic or haemorrhagic or thrombotic stroke ?

    •Ischemic stroke : onset of symptoms usually noticed immediately after waking up from sleep 

    •embolic or haemorrhagic stroke:  onset of symptoms during activities

    •Embolic stroke : history of cardiac diseases like RHD or Atrial fibrillation is present

    • haemorrhagic stroke: history of raised ICT - headache, nausea,vomiting etc. present


4. Importance of CIMT : CONSTRAINT INDUCED MOVEMENT THERAPY


5. Importance of proper clinical evaluation 





Comments

Post a Comment

Popular posts from this blog

9M LEFT GROSS HYDRONEPHROSIS

Image
 A 9 years old male who is a school going student came with C/O     left loin pain since 2 months, intermittent episodes of pain abdomen (about 2-3days of pain per week). C/o decreased urine output, with dribbling of urine, thin & poor stream, with post void residue + (not relieved completely). C/o fever, moderate grade, intermittent, about 1 ep in a week.  H/o nausea +,  Decreased appetite+. Patient was apparently asymptomatic 6 years, 3 months back then the patient's attender's started noticing increased abdominal girth and distended abdomen when the patient was just 3 years old i.e, approximately around jan/Feb/March - 2018. The child was born on 25/02/2005. He appeared healthy at birth. APRIL, 2019. In 2019, child had episodes of pain abdomen for which he was advised USG abdomen - incidentally it was found that the child had solitary kidney. In 2019, he was taken to Urologist in West Bengal, who apparently informed the attenders about the child's condition (and alle
Read more

65 Y OLD WITH HEMIPLEGIA

Image
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. Patient and his/her attenders have been informed and their consent has been taken. 65 yr old female was brought to the casualty with complaints of Difficulty in moving upper limbs and lower limbs since 3 days
Read more

40M TYPE 1 DIABETES MELLITUS WITH UNCONTROLLED SUGARS, ATROPHIED PANCREAS

Image
 A 40 years old male, an auto driver by occupation came to OPD with C/O   loss of consciousness at around 3 am since 20 days C/O nausea since 1 week C/O weakness since 1 week HOPI  :  Patient was apparently asymptomatic 20 days ago then developed hypoglycemic symptoms at around 3 am and patient became unresponsive. Hypoglycemic symptoms were relieved on having some sugar syrup or chocolate. Similar episode has been occurring on a daily basis from the past 1 week. H/O of increased physical activity beyond patient's usual routine from past 20 days                                     ⬇️    H/O of which hypoglycemic event occurred early in morning  No h/o sweating, palpitations during that episode.  No h/o vomiting, blurring of vision during that episode  No h/o of fever No h/o pain abdomen, loose stools  No h/o burning micturition, decreased urine output  No h/o polyurea , polydypsia , polyphagia  No h/o similar complaints in day time  Year -2001   23 years ago, he experienced head tr
Read more