Question

A 58-year-old man presented with sudden onset of complete left-sided paralysis and slurred speech. The head CT in the ER demonstrated evidence of early edematous changes in the distribution of the right middle cerebral artery (MCA). A head CT 2 days later showed a very large right hemisphere infarction involving the entire right MCA territory. He had been somewhat drowsy but easily aroused during the first few days of hospitalization. He also had a right gaze preference, left hemineglect, and severe left hemiplegia. He became more lethargic after the first few days, and then could not be aroused. He was placed on mechanical ventilation due to respiratory difficulties. Examination in the ICU revealed that he was comatose (a sleep-like state from which one cannot be aroused). His right pupil was fixed and dilated. Other brainstem reflexes were intact. There was no movement elicited on the left side, but there was some movement following stimulation on the right. However, there was a Babinski reflex (extensor plantar response) present on the right (indicating dysfunction of the descending motor tracts controlling the right side of the body). There was subsequent deterioration of the patient's condition. He eventually lost all his brainstem reflexes (pupils became unresponsive to light, eye blink to corneal touch was lost, spontaneous respiratory effort ceased, etc.). All limb movement was lost. Brain death was confirmed.

what is the diagnosis, prognosis, and treatment options?

what is the diagnosis, prognosis, and treatment options?

Answer 1

Diagnosis:-

The diagnosis of the given case is Stroke as the patient presented with sudden onset of complete left sided paralysis, Slurred speech.As the time progresses the patient has vision problems ,become lethergy ,breathing difficultly and finally comatose. CT scan finding revealed a very large right hemisphere infarction involving the entire right middle cerebral artery(MCA).

Prognosis:-

Prognosis depends on the type of stroke,degree and duration of instruction or hemorrhage and extent of brain tissue damage.Immediate treatment can help improve patient in many cases but in some case especially in older people like this presented case of a 58 yr old male prognosis may not be good and it can lead to permanent disability like walking,speeching, vision and ultimately leading to death.

Treatment options:-

Treatment for stroke depends on type of stroke whether ischemic stroke or a stroke that involves bleeding into the brain.

In this case,patient is in ischemic stroke.To treat this,doctor must quickly restore blood flow to brain.This may be done with:-

a)Emergency IV medication such as an injection of Tissue plasminogen activator(tPA).

b)Emergency Endovascular procedure which includes medication delievered directly to the brain or removing the clot with a stent retriever.

c) Other treatment option include carotid endarterectomy ,Angioplasty and stents.