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  #1  
Old 03-23-2012
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Neuro How would you manage this stroke patient!

A 22-year-old male abuser of intravenous heroin complained of severe headache while having sexual intercourse. Within a few minutes of that complaint, he developed right-sided weakness and became stuporous. His neurologic examination revealed neck stiffness, as well as right arm and face weakness. An unenhanced, emergency CT scan revealed a lesion of 3 to 4 cm in the cortex of the left parietal lobe. The addition of contrast enhancement revealed two other smaller lesions in the right frontal lobe but did not alter the appearance of the lesion in the left parietal lobe.

Within a day of admission, the right-sided weakness began to abate and within a week it completely resolved. On the fourth day of hospitalization, the patient abruptly lost consciousness and exhibited clonic movements starting on his right side and generalizing to his left side.

The movements stopped within 3 min, but he had residual right-sided weakness for 24 h. The CT scan was unchanged from that obtained on admission. The most appropriate treatment to institute involves

a. Heparin
b. Recombinant tissue plasminogen activator (r-TPA)
c. Urokinase
d. Phenytoin
e. Warfarin
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  #2  
Old 03-23-2012
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Thats a pretty much huge lesion...
Ok I have no clue.

For him to have embols in the head he should have ASD or VSD...
Talk from the heroin couldn't cause that damage either...
He is young and is sexually active... Might have AIDS
The contrast CT only showed those small lesions.

Man, I think its herpes...
Next time he sizes - I think he should be given phenytoin...

I go with D

homa_7 - note I said D (not c or z )
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Old 03-23-2012
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Phenytoin??? not too sure
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I think its A ..... the tumours are releasing thromboplastin which leads to clotting and when the clot is normally lysed by the plasmin his symptoms resolve ......... heparin will prevent futher clots ........
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I think its A ..... the tumours are releasing thromboplastin which leads to clotting and when the clot is normally lysed by the plasmin his symptoms resolve ......... heparin will prevent futher clots ........
Why not warfarin then? He isnot going to get pregnant since warfarin is given with trousseau migratory thrombophlebitis ...
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Why not warfarin then? He isnot going to get pregnant since warfarin is given with trousseau migratory thrombophlebitis ...
, Heparin is always given in a acute setting , then shifted to warfarin for long term .......
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Old 03-23-2012
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, Heparin is always given in a acute setting , then shifted to warfarin for long term .......
You give em both, cuz warfarin will take time to kick in (like diazepines + ssri in severe depression)
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Quote:
Originally Posted by DocSikorski View Post
Thats a pretty much huge lesion...
Ok I have no clue.

For him to have embols in the head he should have ASD or VSD...
Talk from the heroin couldn't cause that damage either...
He is young and is sexually active... Might have AIDS
The contrast CT only showed those small lesions.

Man, I think its herpes...
Next time he sizes - I think he should be given phenytoin...

I go with D

homa_7 - note I said D (not c or z )
I'm so sorry DocSikorski, but what do you mean "I will have that power (c)"
my english language is not very good.
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Originally Posted by homa_7 View Post
I'm so sorry DocSikorski, but what do you mean "I will have that power (c)"
my english language is not very good.
A quote from one of my favorite tracks. It uses a sample from an old tv show "dr Who"
It is my signature( you may see people having signatures under their posts, you might add one too in your settings )
So what's the answer?
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  #10  
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Default Seizures

This young man almost certainly has numerous problems associated with his intravenous drug abuse, but the cause of his current complaints is most likely bleeding from a mycotic aneurysm. Aneurysms are especially likely to bleed during exertion, such as that associated with sexual intercourse or defecation. That the lesion appeared largely the same on unenhanced and enhanced CT scans suggests that it is a hematoma.

Anticoagulation with warfarin or heparin and thrombolysis with r-TPA or urokinase are contraindicated in anyone with an intracranial hemorrhage. Focal seizures that secondarily generalize after an intracerebral or subarachnoid hemorrhage occur frequently and are appropriately treated with an antiepileptic drug, such as phenytoin (Dilantin).
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  #11  
Old 03-23-2012
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Give a freakin cigar to freakin doc Sikorski!
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Originally Posted by homa_7 View Post
This young man almost certainly has numerous problems associated with his intravenous drug abuse, but the cause of his current complaints is most likely bleeding from a mycotic aneurysm. Aneurysms are especially likely to bleed during exertion, such as that associated with sexual intercourse or defecation. That the lesion appeared largely the same on unenhanced and enhanced CT scans suggests that it is a hematoma.

Anticoagulation with warfarin or heparin and thrombolysis with r-TPA or urokinase are contraindicated in anyone with an intracranial hemorrhage. Focal seizures that secondarily generalize after an intracerebral or subarachnoid hemorrhage occur frequently and are appropriately treated with an antiepileptic drug, such as phenytoin (Dilantin).

Had he been bleeding it would be seen in the CT scan , you said non enhanced Ct scan shows a lesion ( could be bleeding or tumour or aneurysms ) but to see more on a enhanced one rules out bleeding ...... or hematomas which are clearly seen on non enhanced one ....

anyways Give A Cigar to Docsikorski .... ......great diagnosis Sir ........
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  #13  
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Originally Posted by Hitman View Post
Had he been bleeding it would be seen in the CT scan , you said non enhanced Ct scan shows a lesion ( could be bleeding or tumour or aneurysms ) but to see more on a enhanced one rules out bleeding ...... or hematomas which are clearly seen on non enhanced one ....

anyways Give A Cigar to Docsikorski .... ......great diagnosis Sir ........
hmmm nice point about CT...
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