an overweight 70yr old patient was admitted in hospital with slurred speech,righ
ID: 3514430 • Letter: A
Question
an overweight 70yr old patient was admitted in hospital with slurred speech,right hand numbness,weak left hand grip,with rt sided showing signs of facial paraylsis for nearly 3 days.He told doctirs that he has been smoking for 44yrs.His father had adultonset of diabetis and died at the age of 64.One of his brothers has subarachnoid haemorrhage and died at the age of 63.The other brother is hemiparetic because of CVA.One brotheris suffering from hypertension but the remaining siblings are healthy.Vital signs such as his body temperature,breathing was normal but heart rate and blood pressure was severly elevated.An analysisof CSF showed normal blood protein and glucose levels.ECG was normal but EEG and CT showed high activity and increase density of the left hemisphere respectively.His clinical chemistry results indicate elevated blood glucose.
Use the patients clinical conditions,family history to establish diagnosis and describe the disease process investigations and expected treatment
Explanation / Answer
The patient's EEG [ electroencephalogram ] shows high activity. This indicates hyperactivity of the brain which is generally caused in a seizure. This is further confirmed by the symptom of weakness in his left arm and slurred speech.
The patient has a family history of hypertention, paralysis and death due to brain haemorrage . All these point to a family history of hypertion. Added to this , he has been smoking for most of his life. Thus, it is not surprising that brain cells have been seriously affected. Surprisingly, the heart seems to be normal [ as per the readings of the ECG] except for the increased heart rate.
The CT scan of the brain shows high density of the left hemisphere of the brain. This might be the cause of the left sided facial paralysis.
So, the diagnosis would be that the patient is suffering from a mild brain stroke. The treatment will begin with medication followed by supportive care , therapies and preventive measures.
Medication will include blood thinners, anti hypertensive drugs and alteplase to break up any clots that might be blocking the flow of blood.
Cardiac monitoring of the patient will have to be done .
If the speech is still not clear, then a speech therapist will be needed to help the patient in voice rehabilitation.
Last but not the least, the patient will need to be councelled on the importance of being healthy. Since , he is overweight, he will need to reduce with the help of a carefully planned diet and exercise. He will have to QUIT smoking at once .
He will need to go for regular health check ups so that the problem does not re occur. In short, he will have to change his lifestyle and other other potentially harmful habits ,like smoking.
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