Basal artery thrombosis صعوبه التشخيص لعمق الشريان الدماغي
احب ان اعرض حاله لصعوبه تشخيص basal artery thrombosis للطبيب العام وايضا طبيب الاشعه ,لكن لكثره معرفه هذا النوع من الحالات لطبيب الاعصاب لايمكن تجاهلها.
وضعت هذه الحاله فقط للفائده منها وعدم اهمال الاعراض والرجوع دوما لطبيب الاعصاب وطبيب الاشعه لمناقشتها فورا حيث ان نسبه الوفاء 96% اذا لم يتم التدخل السريع.
52yr RHM from home working as a draftsman
PMHx
Dyslipedimia Dx last week-Lipitor 10 mg po od
Dyspepsia-prevacid
No Hx of: HTN, stroke, DM, Trauma....
None-smoker, 4-6 beers/day
Sleep problem NYD
No allergy
, FHx –ve for CVD
HPI:
12:45 PM -while taking shower :
Sudden vertigo
Rt sided (face/arm/leg)numbness
Rt auditory tinnitus
+nausea
Slurred of speech
No weakness
Similar episode two days before-resolved completely within 3 minutes>
This symptoms wax and wean during transfer to UA
NO:H/A, trauma/chiropractic, SOB, CP, fever
O/E: BP 140/80, HR 80/min.NSR,sat.98%RA
NIHSS 6
Normal supratentoria function
No: aphasia, V. Field cut
Sever dysarthia
Bilateral multidirectional mix nystagmous/hypermetria to Rt gaze
Mild Rt Upper CN VII
Rt facial sensory loss (temp.) and Lt body sensory loss (temp.)
Reduce Rt cornea reflex
No drift but mild Rt pyramidal weakness 4++, mid line tongue
Rt arm/leg incoordination
tpa IV was gave urgently after exclusion of major risk factores (IC bleed/recent bleed in 21 days in non compressable sites...see NHSS criteria in another topic here)
end result:
NIHSS score
here:
http://neuae.com/vb/showthread.php?p=3880#post3880
NIHSS: 1
Lt cerebellar infarction rather than death or lock-on case >patient back to work in 3 months, and the cause of his stroke was from his new A.Fib. warfarin sarted (INR 2.0-3.0).
نرجو الفائده من هذه الحاله للاطباء وطلاب الطب-الرجاء الاشاره للموقع عند الاقتباس او النسخ مع مراسله الاداره للموافقه
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مواقع النشر (المفضلة)