A 64-year-old right-handed male is brought to the emergency department by his wife with complaints of sudden onset weakness of the right side of the body and difficulty in speaking for the past 2 hours. The patient was apparently normal before this episode. While having breakfast, he suddenly dropped the cup from his right hand and was unable to stand properly. His speech became slurred and he could not form meaningful sentences.
There is no history of trauma, seizures, or loss of consciousness. No history of similar episodes in the past.
He is a known case of:
-Hypertension for 12 years (poorly controlled)
-Type 2 Diabetes Mellitus for 10 years
-Chronic smoker (20 pack-years)
On examination:
Patient is conscious but appears confused
Blood pressure: 180/110 mmHg
Pulse: 88/min, regular
Respiratory rate: 18/min
Let’s solve this case with these questions!
1.What is the most likely diagnosis in this patient based on the clinical presentation?
2.Which arterial territory is most likely involved?
3.What type of aphasia is suggested by non-fluent speech with preserved comprehension?
4.What is the first-line investigation in the emergency setting for this condition?
5.If the patient presents within the therapeutic window and imaging rules out hemorrhage, what is the next best step in management?
Share your insights, doubts, questions, fun facts regarding the above diagnosis!
@Aniket According to the symptoms you have mentioned and pastnmedical History along with the patients recovery the provisional diagnosis would be acute ischemic strock
For further investigation go with brain CT
Aphasia type I think it’s broca’s aphasia (non fluient comprehension preserved)
Left territory artery involved maybe its (mca) middle cerebral artery.
1.cerebrovascular attack - Most probably haemorragic stroke
2.left arterial teritory
3.brocca’s area
4.CT scan
5.Control blood pressure, Maintain GC score, then when blood pressure is under control.. If bleeding is excessive and pressure increases then craniotomy has to be done.
Based on the patient complaints we can conclude that onset weakness of the right side of the body . we can state a blood vessel supplying the left side of the brain is likely blocked , reducing blood flow. This affects areas controlling movement (right side) and speech, leading to these symptoms. 1. The diagnosis of the patient - Ischemic stroke which occurs due to the sudden reduction or blockage of blood supply to a part of the brain which may leads to Neurological defects .
2. Particularly the left Middle Cerebral Artery . It is responsible for the movement of the face , upper limb and speech . So right sided weakness and difficulty speaking points to a left MCA stroke
The provisional diagnosis can be confirmed by a CT scan of the brain
, reducing blood flow. This affects areas controlling movement (right side) and speech, leading to these symptoms. 1. The diagnosis of the patient - Ischemic stroke which occurs due to the sudden reduction or blockage of blood supply to a part of the brain which may leads to Neurological defects .