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    BST Stroke Infark

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    RagitaAnandhitaPutri
    A 52-year-old female presented with sudden onset left-sided weakness when waking up that morning. On examination, she had right-sided facial palsy and tongue deviation to the left. Medical history was significant for uncontrolled hypertension but no other risk factors. Working diagnosis was right carotid territory cerebral infarction based on clinical presentation and risk factors. Management plan included rehabilitation, hypertension control, and medications.

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    BST Stroke Infark

    Uploaded by

    RagitaAnandhitaPutri
    24 views29 pages
    A 52-year-old female presented with sudden onset left-sided weakness when waking up that morning. On examination, she had right-sided facial palsy and tongue deviation to the left. Medical history was significant for uncontrolled hypertension but no other risk factors. Working diagnosis was right carotid territory cerebral infarction based on clinical presentation and risk factors. Management plan included rehabilitation, hypertension control, and medications.

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    stroke

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    A 52-year-old female presented with sudden onset left-sided weakness when waking up that morning. On examination, she had right-sided facial palsy and tongue deviation to the left. Medical history was significant for uncontrolled hypertension but no other risk factors. Working diagnosis was right carotid territory cerebral infarction based on clinical presentation and risk factors. Management plan included rehabilitation, hypertension control, and medications.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    24 views29 pages

    BST Stroke Infark

    Uploaded by

    RagitaAnandhitaPutri
    A 52-year-old female presented with sudden onset left-sided weakness when waking up that morning. On examination, she had right-sided facial palsy and tongue deviation to the left. Medical history was significant for uncontrolled hypertension but no other risk factors. Working diagnosis was right carotid territory cerebral infarction based on clinical presentation and risk factors. Management plan included rehabilitation, hypertension control, and medications.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 29

    STROKE

    Ragita Anandhita Putri


    1115076
    Preceptor : dr. Yenny SpKFR
    Indentity
    Name : mrs. A
    Age : 52 y.o
    Sex : Female
    Address : Bandung
    Occupation : Houswife
    Religion : Moeslem
    Marital status : Married
    Anamnesis
    Chief complaint : left sided weakness.
    Specific history :
    A day before examination, patient suddenly
    felt weakness of her left arm and left leg when
    she woke up in the morning. Patien hard to
    stand, she can just raise her arm and leg for
    seconds and mouth deviation to the right.
    The patient denies feeling headache, nausea,
    vomitting, ringing of the ear, seizures, loss of
    consciousness, blurred or double vision. Patient
    did not fall or had a head injury before.
    Past Medical History
    Patients had never experienced a complaint like this
    before.
    Uncontrolled high blood pressure
    No history of diabetes, heart disease, or previous stroke
    Family Medical History : patient has no families
    whose
    complaint like this.
    Habits : rarely exercise, likes eating fatty food. No
    smoking or drinking alcohol
    Effort in medication : none
    Drug allergies : none
    Physical Examination
    Consciousness : compos mentis
    Weight = 70 kg, Height : 160 cm
    BMI= 27,34 kg/m2 ( overweight )
    Vital sign
    Blood pressure : 130/80 mmHg
    Heart rate : 84x/menit
    Respiration rate : 20x/menit
    Temperature : 360C
    General Examination

    Head : within normal limits


    Neck : within normal limits
    Thorax : within normal limits
    Abdomen : within normal limits
    Extremity : within normal limits
    Blood vessel : within normal limits
    Neurological Examination
    Appearance
    Head : normal size and shape
    Vertebral column : normal
    Meningeal sign
    Nuchal rigidity -
    Brudzinsky I -
    Brudzinsky II -
    Brudzinsky III -
    Kernig -
    La seque -
    Cranial Nerve
    CN I
    Olfactory : normosmia
    CN II
    Visual acuity test : normal
    Confrontation test : good
    Funduscopy : not performed
    CN III/IV/VI
    Ptosis (-)
    Pupil round, isochors, 3 mm
    Indirect light reflex (+/+), Direct light reflex(+/+)
    Eye movement : good in every direction
    CN V
    Sensory
    Ophtalmic +/+
    Maxillary +/+
    Mandibular +/+
    Motoric normal
    CN VII
    Eyebrow movement : normal, symetric
    Eye closure : normal
    Nasolabial plica : asymmetric, flat at left
    nasolabialis plica
    Facial movement : asymmetric, mouth is inclined
    to the right
    2/3 anterior tongue tasting : not performed
    CN VIII
    Hearing : normal
    Balance : not performed
    CN IX/X
    Voice : dysphonia (-)
    Swalowing : disphagia (-)
    Pharyngeal arched : symmetrical
    Uvula : central
    Palatum contraction: symmetrical
    Pharyngeal reflex : not performed
    1/3 posterior tasting : not performed
    CN XI
    Shoulder lift : normal
    Left and right head movement : within normal limits
    CN XII
    Left sided tongue deviation
    Atrophy -
    Tremor/fasiculation -/-
    Motoric Examination
    Strength Tonus atrofi fasiculation

    Upper 5|3 normotoni -/- -/-


    extremity
    Lower 5|3 normotoni -/- -/-
    extremity

    Gait : not performed


    Involuntary movement -
    Sensory Examination
    Upper limbs, trunk, lower limbs : within
    normal limits
    Coordination Test not perfomed
    Physiological Reflex:
    Biceps : +/+
    Triceps : +/+
    Radius : +/+
    Ulnar : +/+
    KPR : +/+
    APR : +/+
    Epigastric : not examined
    Mesogastric : not examined
    Hypogastric : not examined
    Cremaster : not examined
    Pathological Reflex:
    Hofman trommer : -/-
    Babinsky : -/+
    Chaddock : -/+
    Oppenheim : -/-
    Gordon : -/-
    Schaeffer : -/-
    Clonus : -/-
    Primitive reflex : glabella ()
    rooting ()
    palmo mental ()
    Cognitive Examination
    Psychological connection : Good
    Motoric aphasia :-
    Sensory aphasia :-
    Short memory term : within normal
    limits
    Long memory term : within normal
    limits
    Calculation ability : Good
    Resume
    Chief complaint : left sided weakness.
    Specific history :
    A 52 yo female suddenly felt weakness of her left
    arm and left leg when she woke up in the morning, 1
    day before examination. Patien hard to stand, she can
    just raise her arm and leg for seconds and mouth
    deviation to the right.
    Patient denies vomit, vertigo, seizure, headache,
    ringing of the ear, loss of conciousness, blurred or
    diplopia, injury history (-)
    Past Medical History :
    Patients had never experienced a complaint like this
    before.
    Uncontrolled high blood pressure
    No history of diabetes, heart disease, or previous
    stroke

    Family Medical History : patient has no families


    whose complaint like this.

    Habits : rarely exercise, likes eating fatty


    food. No smoking or drinking
    alcohol
    Effort in medication : none

    Drug allergies : none


    Physical examination
    Consciousness : compos mentis
    Weight = 70 kg, Height : 160 cm
    BMI= 27,34 kg/m2 ( overweight )
    Vital sign
    Blood pressure : 130/80 mmHg
    Heart rate : 84x/menit
    Respiration rate : 20x/menit
    Temperature : 360C
    General examination : within normal limits
    Meningeal sign -
    Cranial Nerve
    right sided central CN VII paresis
    Right sided central CN XII paresis
    Motoric :
    Upper limb : 5|3, normotoni
    Lower limb : 5|3, normotoni
    Sensory within normal limits
    Physiological reflex : +/+
    Pathological reflex : -/+
    Proposal Checks
    Ct scan
    PT/apTT
    Blood glucose
    Lipid profile
    Working Diagnosis
    Clinical : left sided hemiparese
    Localitation : Right carotid system
    Etiology : cerebral infarction
    Risk Factor : hypertension
    Proposal Management
    Non-Medikamentosa
    Medical rehabilitation
    Control the hypertention
    Medikamentosa
    Aspilet tab 80mg 1 x1
    Amlodipin tab 5mg 1 x1
    Prognosis
    Ad vitam : ad bonam
    Ad functionam : dubia ad bonam
    Ad sanationam : dubia ad bonam
    Rehabilitation Program in Stroke Patients

    Initial Phase
    Aims to prevent secondary complications and
    protect remaining functions.
    Includes proper bed positioning, range-of-
    motion exercises, electrical stimulation, and
    emotional therapy.
    Continuation Phase
    Aims to achieve functional independence in
    daily mobilization and activities.
    Physiotherapy:
    Electrical stimulation for weak muscles
    (muscle strength of 2 or less)
    Superficial heat therapy (infrared) to loosen
    muscle stiffness
    Passive or active range of motion exercises
    Muscle strength exercises
    Muscle facilitation or reduction exercise
    Mobilization exercise
    Speech therapy
    Mirror exercises to train tongue and lip movements
    and word pronunciations
    Word articulation exercises in dysarthria patients
    Therapy may be performed by the medical team or
    the patients family
    Psychological therapy
    Social therapy

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