A patient male, 56 yo, addmited the Can Tho S.I.S hospital because of dilirium.
History of present illness: The disease started suddenly about 4 hours before the patient was admitted to the hospital, He had a left hemiplegia ,dysarthria, Delirium 🡪 admitted.
Past medical and surgical history: Hypertension
Physical exam:
MRI brain: extensive cerebral infarction in the right hemisphere, occlusion of the right middle cerebral artery in the acute phase.
Initial treatment :
==> 2nd day:
=>Treatment:
CT scan brain:
Chest X-ray: right lower lobe inflammation
Final diagnose: Decompressive craniectomy in the postoperative condition/ Hypertion/ Hospital acquired pneumonia (HAP)/Hypokalemia
Treatment :
=> He was discharged from hospital after #3,5 weeks:
History of present illness: The disease started suddenly about 4 hours before the patient was admitted to the hospital, He had a left hemiplegia ,dysarthria, Delirium 🡪 admitted.
Past medical and surgical history: Hypertension
Physical exam:
- Vital sign: Pulse 84 bpm, Temp 37oC, BP 140/90 mmHg, RR 15 bpm
- Neurologic exams: delirium ,Glasgow score 11 , pupil reflex (+) on both sides, left Facial Droop
- Cardiac and pulmonary exams: No abnormal
| CBC |
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| Electrolyte |
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| Blood biochemistry |
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MRI brain: extensive cerebral infarction in the right hemisphere, occlusion of the right middle cerebral artery in the acute phase.
Initial treatment :
- Natri chlorid 0,9% 500ml IV
- Amiparen 10% 500ml IV + Lipofundin 20% 250ml IV
- Pentasec 40mg IV
- Somazina 0,5g IV
- Paracetamol 1g IV
- Fentanyl 0.1mg IV
==> 2nd day:
- Coma, Glasgow score 6 (E1M4V1)
- BP: 130/70 mmhg
- HR: 80 bpm
- Right pupil size # 3.5 mm, reflex (-)
- Left pupil size # 2.5 mm, reflex (+)
=>Treatment:
- Osmofundin 20% 250ml IV C dpm
- Decompressive craniectomy
CT scan brain:
- Extensive cerebral infarction in the right hemisphere
- Hemorrhagic transformation in acute ischemic stroke at the frontal horn of the right lateral ventricle.
- Brain midline shift of over 15 mm
Chest X-ray: right lower lobe inflammation
Final diagnose: Decompressive craniectomy in the postoperative condition/ Hypertion/ Hospital acquired pneumonia (HAP)/Hypokalemia
Treatment :
- Fluid: Natri chlorid 0,9% 500ml IV
- Nutrition: Amiparen 10% 500ml IV + Lipofundin 20% 250ml IV
- PPI: Pantoprazol 40mg IV
- Citicoline 0,5g IV, Paracetamol 1g IV
- Antibiotic: Ceftriaxon 2g IV q.24h + Levofloxacin 0.75g IV q.24h
- Nicardipine IV
- Physical therapy twice a day
- Weaning from mechanical ventilation , extubation
=> He was discharged from hospital after #3,5 weeks:
- Glasgow score 13
- Left hemiparesis improvement 1/5