Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The first problem. HEMIPLEGIA * in common older P4 ours w " "" Spontaneous " " "" Ima concomitantornotion " " Stroke ( ✗ 3} • * contra in ^ , / Indications indication : ↳ ↳ • traumatic . hemorrhages " ?ÉÑ¥É%¥% * * ] (↳ , vs Vision deficit , * through ff > * Initial part : step 1/2 extrapyramidal Go * ischemic stroke within limits no ↳ T V5 ↳ 4.5 hrs age contraindication : risk of internal bleeding uncontrolled arterial dicah } . * after HT ( > esp is . -4 procedure ! i. vascular problems g. = ☐ m ! Circulations * thrombolysis mechanical hemorrhage intracranial traumatic brain post " ↳ - common complication acute if of cerebral vessels ( upto 6hrs0, blockageof blockage ( no A. basilar is < 4.5 defined time limit ) hrs IV lhrombolysis therapy) Anamnesis: Anamnesis was obtained with the help of his wife because the patient cannot talk, he is able to pronounce just few sounds although can understand what others are saying. Three months ago, after a night sleep the patient experienced numbness of the right arm, however, the symptoms resolved in about half an hour. The patient assumed that his arm became numb because he might have overlain it while sleeping.. A few days ago while watching TV the patients lost his vision in to his left eye. A few minutes later his vision recovered and the patient did not seek for a medical due compressi on (TIA) consultation. This morning after night sleep his wife has noticed that her husband could not talk, his • In mouth was deviated to the left, he could not move his right arm, could not sit down or stand up by transitory himself. She immediately called for the emergency. I . Anamnesis vitae: Arterial hypertension has been diagnosed 10 years ago, and the patient received a 5mg daily. He had no traumas or operations, no allergies. Habits: Since the age of 20 years of age, the patient smokes one package of cigarettes and drinks one glass of wine daily. He d e e e ci e, alk l a li le. Lately, the patient has been concerned about his job because his employer bank undergoes reorganization and re-certification of the employees. Clinical examination: General condition is normal. The patient is overweighted. Body temperature is Atherosclerotic stenosis normal. Lymphatic nodes and thyroid gland are of normal size. Cardiac tones are rhythmical, pulse Uncontrolled HT 80 per minute. BP 190/110 mmHg. Peripheral arterial pulse can be palpated. Murmur in the regiono Dyslipidemia Paroxysmal arytnmia of the left carotid artery can be auscultated. Auscultation of the heart and lungs does not reveal any changes. Examination of other systems does not show any deviations. Risk factors * * * * I Neurological examination: The a ie i i f ll c ci e , ell ie ed. He d e alk b i able c m ehe d ① ! and can perform given tasks. The right nasolabial fold is shallow (less expressed), the right angle of stag the lip is deviated. Full right side hemiplegia with increased muscle tone and increased strech reflexes is present. Abdominal reflexes are absent on the right. Positive Babinski sign on the right. ← I?) No sensory disturbances have been detected. How you would define speech/language disturbance? symptoms ? How you would define the paralysis of the lower part of the face and the right extremities? presented Which functions of the nervous system are damaged? w/ suspicion young patient ( Transient ischemic attacks ( episodes) Where is the lesion localized? UMN lesion ( contralateral) ) ER though What is the possible etiology? Acute vascular disorder/ stroke ( 3rd episode ) artery) ER What differential diagnosis should be made? Tumor ischemic Which additional diagnostics tests should be performed? CT w/o contrast hemorrhagic? Motor aphasia w/ CT ? acute How big is the urgency of ths event? ABC thrombosis protocol angiography lesion in Broka 's any ECG left What treatment should be started? glucose ( cortex ) lesion Liver/ renal function hemisphere Rehab control Aspirin heparin IV ( prophylaxis of statins lesion TBP ) electrolytes lung shallow Students should request for additional anamnestic data and supplementary tests (prepared facial CN nasolabial stable condition Vision Deficit Transcranial doppler separately) if > 70% stenosis * Ask time the first * > acute or chronic If of vasculitis , not MR2 in [ • I -2 * * vasculitis metastasis Ms ( cerebral , , , ~ or > • " " • > . ↳ in - ↳ • , , ' in thrombosis • 02 • ↳ → fold • Hemiplegia w/ CNS • L . eye • ↳ [analyse sign ( UMN paralysis loss of vision ( Babinsky (the temporary arteries ) ] T non - department { Neurology specific; deep tendon reflex ) * * Neck US ( carotid arteries) * Cholesterol + lipids levels ✓ * * warning sign suspect of " amaurosis a stroke fugax due ↳ blood clot dislodged reduced > m . cerebral arteries ( commonly plaque blood / } flow due to carotid artery blockage ) bleeding ) > redo CT24 hrs later ' lhrombolectomy , additionally injury qq.gg#;yg.;EYm Emergency room Mr J.J., 60 year-old bank officer was admitted to the emergency room due to development of weakness in the right limbs and inability to talk. * intracerebral ,oommµg start • giant therapy Pathways by which Pyramidal motor signals are sent from brain > LMN > innervates mm produce * * Originates Carries motor in Responsible movement Extrapyramidal tracts ✓ * to tracts ✓ cerebral cortex fibres to for spinal voluntary control * cord 3 brainstem of the musculature of the body 3 face Originates in the brainstem * Carries motor fibres to * Responsible control for involuntary muscle tone ↳ balance ^ ^ spinal ↳ posture ↳ locomotion cord 3 autonomic of all musculature , such ↳ I the as : * Middle cerebral * Embolism from I. carotid stenosis artery > a. supplies ophthalmic face > disturbed i reverse a. flow of blood * * * stenosis Cortiaobulbar tract cerebral trauma Lower Left frontal , damage → hemisphere > facial dysarthria → speech impairment i cortical 1- UMN " * * / frontal lesion Alternating syndrome " when lesion → in Arch of reflex central > specific Thrombolysisz ↳ w/ 6 hrs > carotid 12 his > vestibular basilar ischemic stroke I 30% paralysis treatment ✓ acute ( ventral part ) brainstem damage * pathology region ischemic stroke > transient vision loss ganglia * Basal * Brainstem * Cerebellum ( pons ) ✗ Step 2/2 The further course of the disease: The patient is slowly getting better. Twelve days following the beginning of the disease he still experiences difficulties in talking, there is slight asymmetry of the face because of the less expressed nasolabial fold. The patient can move his right arm but cannot move his hand. Muscle tone in the hand and arm is increased, spastic. Reflexes on the right upper extremity are brisk, with outspread reflexogenic zones. Muscle strength in the legs allows standing. Muscle tone of the right leg is increased, patellar and Achille tendon reflexes are exagerated, ancle clonus and Babinski sign are present. The patient walks with extended leg and holds his right arm in flexed position. R¥ Wernicke 's < position What further management is needed for this patient? Aspirin 3-4 months §☐fo× for flexion ( functionality T ) ( pain ) periodically General content of the problem: Clinical problem Speech disturbance and right-sided paralysis in the patient who experienced transitory blindness and numbness of the right arm and who is smoking, has increased BP and limited physical activity. Diagnosis Ishaemic stroke in the region of the left a. carotis Nosologic entity Stroke Risk factors of cardiovascular diseases Most important aspects Anamnesis with evaluation of all circumstances, clinical and neurological examination. Differential diagnosis Search for etiology Treatment of the acute stage and secondary prophylaxis Prophylaxis of complications Rehabilitation Setting Emergency room Department of Neurology Learning objectives: Upon accomplishment of this problem, the students are expected to know the following: Diagnose stroke on the basis of anamnestic data and clinical evaluation; Recognize the importance of transitory ischaemic attack as a risk factor for development of stroke; Diagnose the different types of acute stroke and be able to make differential diagnosis; Be aware of the complementary tests that should be performed and be able to interpret them; Know the main etiology of stroke; Know the main risk factors for the development of stroke.; Know the principles of the treatment in acute stage and secondary prophylaxis; Understand the importance of rehabilitation and socio-economic consequences of disability. < > Subject - Neurology Responsible Department – Neurology Literature: Basic: 1. Mattle H, Mumenthaler M. Fundamentals of Neurology: An Illustrated Guide. 2nd ed. Chapters 1-5, 12. 2. Simon RP, Aminoff MJ, Greenberg DA. Clinical Neurology, 10th edition.: McGraw-Hill, New York, 2018. 3. Lectures in clinical neurology. Supplementary: 4. Duus P. Topical Diagnosis in Neurology. New York, 2012. 5. www.emedicine.com