Initial Diagnostics CT –Malacic changes, CBC –Hgb 138 –Hct.42 –WBC 8.5 N.72 L.24 M.04 –PC...
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Initial Diagnostics • CT – Malacic changes, • CBC – Hgb 138 – Hct .42 – WBC 8.5 • N .72 • L .24 • M .04 – PC 137 • PT 12.2 • INR 0.89 • ALT 27.04 (10-40) • BUN 4.48 • Crea 99.01 (45-84) • Na 137 (135-145) • K 3.9 (3.6-5) • Lipid Profile (results to follow)
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Transcript of Initial Diagnostics CT –Malacic changes, CBC –Hgb 138 –Hct.42 –WBC 8.5 N.72 L.24 M.04 –PC...
Initial Diagnostics
• CT– Malacic changes,
• CBC– Hgb 138– Hct .42– WBC 8.5
• N .72• L .24• M .04
– PC 137
• PT 12.2• INR 0.89• ALT 27.04 (10-40)• BUN 4.48• Crea 99.01 (45-84)• Na 137 (135-145)• K 3.9 (3.6-5)• Lipid Profile (results
to follow)
Initial Management
• Phenytoin– Loading dose 1gm– Maintained at 1000 mg/cap TID
• Admit to ACSU– Cardiac, CBG monitoring– O2 Support, seizure precauutions
• Diazepam 5 mg IV• Ketorolac 30 mg IV then q8 prn for headache• Continue maintenance medications
Day 1 -3 (Nov 7-9)
S O A PNo recurrence of seizure
Some difficulty sleeping
GCS 15
Stable vitals
Clear breath sounds
NRRR, distinct S1/S2
Soft abdomen
CBG=256 mg/dL
Post-stroke seizure
Hypertension
DM 2
Dx:
MRI, MRA, MRV (Nov 8 / 9)
Tx:
Citicholine
Insuline glulisine
Possible discharge Nov. 11
Imaging Results
• MRI: No aneurysm or any significant stenosis or vascular malformations seen
• MRV: No evident cortical vein or dural sinus thrombosis
Day 4 (Nov 10)
S O A P
Asymptomatic: (-) palpitations, chest pain, dizziness
Atrial Fibrillation in RVR recorded for 3 hours (3:40 am)
Paroxysmal AF Dx: 12L ECG
Tx: Bisoprolol
Cardio referral
Cardio: BP 116 / 77HR 52Sinus bradycardiaGood S1, NRRR (-) carotid bruit
Paroxysmal AF, now back in sinus
Hypertension, stage 2
Dx: 2D ECHO TFTs
Tx: Amlodipine,
Enoxaparine,
Clonidine,
ISMN
Neuro:
No recurrence of seizures
MRI/MRA/MRVCholesterol 3.75 (3.4 – 5.2)
HDL 2.33 (high)
LDL 1.39
Triglycerides 0.93
vLDL 0.42
Post Gliotic Seizure
CVD infarct, Right MCA
Tx: Levetiracetam, Sitagliptin
Diagnostics
• ECG: Atrial Fibrillation, RVR• TFT:
– TSH 3.01 uIU/mL– FT3 2 pg/mL– FT4 0.83 ng.dL
• EEG: abnormal EEG due to a focal theta slowing on the right temporo-parietal occipital region with wave epileptiform discharges on the right temporp-occipital region consistent wih a focal cerebral dyusfunction and a tendency toward localization-related seizures at the right temporo-occipital region
Day 5-7 (Nov 11-13)
S O A P
Neuro/Cardio:
Asymptomatic
Comfortable
No recurrence of AF, seizures
GCS 15
Stable vitals
Clear breath sounds
NRRR, distinct S1/S2
Soft abdomen
Post-Gliotic Seizure
Paroxysmal AF
Hypertension
DM 2
Tx:
d/c Amlodipine, Enoxaparine
start Diltiazem, Dabigatran
Cardio: MGH (11/12); follow up OPD
Neuro: MGH (11/13); follow up OPD
Home Medications
