How to clinically diagnose a stroke lesion? part 1
As a medical student I always feel intimidate to approach a CNS case in ward.
I don't know why but I think I don't really having a good foundation for my neuroanatomy and I always feel they are so tough to comprehend!!!
To become a competent doctor in future... I don't think so it's appropriate to avoid anymore so I started to pick up my neuroanatomy book again !!!
I'm just sharing what I understand at the moment and for disclaimer there might be some error and mistake if anyone of you pick them up, you are welcome to enlighten under the comment :)
Case 1: 65y/o male with underlying DM and hypertension presented with right sided hemiparesis , right sided UMN lesion sign shown at the face and slurring of speech but no difficulty in understanding the command so where is the lesion???
-right sided cranial nerve sign and right sided sensory + motor loss: left sided lesion
-right sided hemiparesis: territory of ACA and MCA compromise ( ACA: lower limb, MCA: Upper limb and Broca's area)
-right sided UMN lesion sign on the face : left sided lesion above pons level
-broca's aphasia: cortical function involved (if cortical function involved, rule out lesion in internal capsule), dominant hemisphere of most people is left side, study shows more than 50% of left handed are left hemisphere dominant too, so it is safe to assume most of the people is left hemisphere dominance.
80% of the stroke are ischemic in nature 20% of them are haemorrhagic. Clinically it is difficult to differentiate both of them however, haemorrhagic stroke is more likely to have headache, vomitting and dizziness prior to the accident but NOT ALWAYS.
The best way to differentiate both of them is NON-contrast CT scan
Ischemic: hypodense (darker)
Haemorrhagic: hyperdense (whiter)
* A repeat CT scan is a MUST as not always the lesion will show changes in the scan at the early stage, a repeat done on day 3-4 may be detect some late changes.
so the clinical diagnosis I will give for this case is : Left sided lesion at the level of internal carotid artery ( before the bifurcation of ACA and MCA, as embolis that separately block the ACA and MCA at the same time is rare)
* and I will order a brain CT to confirm the type of stroke before my management plan.
Just sharing my learning outcome, hope it will helps those who are struggling in CNS cases like I do.
Happy Halloween for those who are celebrating ! Rocks those pumpkins!
Cheers :)
I don't know why but I think I don't really having a good foundation for my neuroanatomy and I always feel they are so tough to comprehend!!!
To become a competent doctor in future... I don't think so it's appropriate to avoid anymore so I started to pick up my neuroanatomy book again !!!
I'm just sharing what I understand at the moment and for disclaimer there might be some error and mistake if anyone of you pick them up, you are welcome to enlighten under the comment :)
Case 1: 65y/o male with underlying DM and hypertension presented with right sided hemiparesis , right sided UMN lesion sign shown at the face and slurring of speech but no difficulty in understanding the command so where is the lesion???
-right sided cranial nerve sign and right sided sensory + motor loss: left sided lesion
-right sided hemiparesis: territory of ACA and MCA compromise ( ACA: lower limb, MCA: Upper limb and Broca's area)
-right sided UMN lesion sign on the face : left sided lesion above pons level
-broca's aphasia: cortical function involved (if cortical function involved, rule out lesion in internal capsule), dominant hemisphere of most people is left side, study shows more than 50% of left handed are left hemisphere dominant too, so it is safe to assume most of the people is left hemisphere dominance.
80% of the stroke are ischemic in nature 20% of them are haemorrhagic. Clinically it is difficult to differentiate both of them however, haemorrhagic stroke is more likely to have headache, vomitting and dizziness prior to the accident but NOT ALWAYS.
The best way to differentiate both of them is NON-contrast CT scan
Ischemic: hypodense (darker)
Haemorrhagic: hyperdense (whiter)
* A repeat CT scan is a MUST as not always the lesion will show changes in the scan at the early stage, a repeat done on day 3-4 may be detect some late changes.
so the clinical diagnosis I will give for this case is : Left sided lesion at the level of internal carotid artery ( before the bifurcation of ACA and MCA, as embolis that separately block the ACA and MCA at the same time is rare)
* and I will order a brain CT to confirm the type of stroke before my management plan.
Just sharing my learning outcome, hope it will helps those who are struggling in CNS cases like I do.
Happy Halloween for those who are celebrating ! Rocks those pumpkins!
Cheers :)
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