HYPERTENSIVE BLEED WITH LEFT FOCAL SEIZURES.pdf

A case presentation on Hypertensive Bleed with Focal seizures

1. HYPERTENSIVE BLEED
WITH LEFT FOCAL SEIZURES
V. GANAPATHI
19353D1009
PHARM. D VI YEAR
JAYAMUKHI COLLEGE OF
PHARMACY
GANAPATHIGREAT
369

2. SUBJECTIVE FINDINGS
A male patient of age 65 years brought to casualty with following
C/O:
oA Episode of seizure like activity up to 5 min. associated with vomiting and
bladder incontinence
oSudden onset of weakness in left upper and lower limb
oDeviation of mouth towards right side
oSlurring of speech
K/C/O:
❖HTN/ T2DM since 30years
❖Old CVA and CKD with BPH
GANAPATHIGREAT
369

3. OBJECTIVE FINDINGS
S.N VITALS INITIAL DAY-1 DAY-2
1 ON EXAMINATION C/C/C C/C/C C/C/C
2 PULSE RATE (bpm) 64 72 81
3 B.P. (mmHg) 190/90 168/88 142/82
4 SpO2 (%) 98% on R.A.. 97% on R.A. 98% on R.A.
5 TEMPERATURE (*F) Afebrile Afebrile Afebrile
6 LUNGS B/L Crepts+ B/L Crepts+ Crepts+↓
7 PARA ABDOMEN Soft, BS+ Soft Soft
8 HEART S1 S2+ S1 S2+ S1 S2+
9 GRBS (mg/dl) 343 228 160
•NOTE: B.P- Blood Pressure, C/C/C- conscious/ coherent/ cooperative, SpO2- saturation of peripheral
oxygen, GRBS- general random blood sugar and RA- room air.
GANAPATHIGREAT
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4. LAB INVESTIGATIONS
S.N PARAMETER NORMAL RANGE RESULTS
1 Haemoglobin (gm) 13-17 10.4
2 RBC Count (M/cumm) 4.5-5.5 3.62
3 WBC Count (C/cumm) 4000-11000 12,900
4 Platelet Count (L/cumm) 1.5-4.5 2.8
5 Urea (mg/dl) 20-40 47
6 Serum Creatinine (mg/dl) 0.7-1.2 2.1
7 Serum Sodium (mmol/L) 136-145 141
8 Serum Potassium (mmol/L) 3.6-5.1 5.4
9 Serum Chloride (mmol/L) 98-108 111
NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.
GANAPATHIGREAT
369

5. IMAGING FINDINGS
MRI BRAIN WITH ANGIOGRAM:
➢Intraventricular hemorrhage in occipital horns of the B/L ventricles
➢SAH in B/L parietal cortical sulci and in right cerebromedullar, cerebellopontine angle cistern
➢Small area of gliosis with hemosiderin deposition in B/L lentiform nucleus
➢Small chronic infarcts in left periventricular white matter
➢Normal study of angiogram
➢Few small areas of SWI blooming seen in the pons ---likely microbleeds
USD ABDOMEN & PELVIS:
➢B/L Renal parenchymal changes, Grade-I
➢ B/L Renal calculi
GANAPATHIGREAT
369

6. ASSESSMENT
❑On the basis of subjective, objective and imaging finding confirms
that the patient has been diagnosed with Hypertensive Bleed with left
focal seizure
❑K/C/O: Recurrent CVA/ HTN/ T2DM/ CKD WITH BPH
GANAPATHIGREAT
369

7. PHARMACOLOGICAL THERAPY
S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
1 MONOCEF CEFTRIAXONE 1000MG IV TWICE D1-D7
2 PAN PANTOPRAOLE 40MG IV ONCE D1-D7
3 LEVIPIL LEVETIRACETAM 500MG IV TWICE D1-D7
4 STROCIT CITICOLINE 500MG IV TWICE D1-D7
5 CARGO-M LEVOCARNITINE &
BISGLYCINATE
500/350MG PO TWICE D1-D7
6 NEFROSAVE TAURINE &
ACETYLCYSTEINE
500/150MG PO TWICE D1-D7
7 ARKAMINE CLONIDINE 0.2MG PO THRICE D1-D7
8 NICARDIA NIFEDIPINE 20MG PO THRICE D1-D7
9MINIPRESS-XL PRAZOSIN 2.5MG PO TWICE D1-D7
10 DAYVIGO LEMBOREXANT 10MG PO ONCE D1-D7
11NEXITO FORTE CLONAEPAM &
ESCITALOPRAM
0.5/10MG PO TWICE D1-D7
GANAPATHIGREAT
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8. PATIENT EDUCATION
❑Take medicine as advised by the physician regularly
❑Completely avoid alcohol and smoking
❑Stress management with yoga and meditation
❑Avoid spicy, oily and highly processed food
❑In case of any weakness in limbs, slurry speech, persistent headache,
SOB and decreased urine immediately seek medical advise
GANAPATHIGREAT
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9. HAVE A GOOD DAY
GANAPATHIGREAT
369
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