2. PRE TEST QUESTIONS
• All patients with stroke should receive aspirin irrespective of CT findings? Y/N
• Window period for thrombolysis of stroke is 12 hours?
• Rapid reduction of BP to normal values in stroke is important ?
3. • Hypothermia is dangerous in stroke ?
• First drug in Status epilepticus is sodium valproate?
• In management of convulsions providing metallic key to patient is very important
?
4. Case 1
60 year old male
c/o slurring of speech -1
hour
Deviation of angle of
mouth – 1 hour
No headache
No vomiting
No fever
Past : HTN since 5 years on
irregular treatment
Family : nothing
contributory
Personal : smoking since
years
Case 2
48 year old male
c/o sudden onset of
weakness in left upper
limb and lower limb
since 1 hour
h/o severe headache –
1 hour
Loss of consciousness
h/o 1 episode of
convulsion
Past : HTN since 5
years not on regular
treatment
FAMILY : stroke in
father at age of 60
Personal : none
Case 3
28 year old male
k/c/o of epilepsy since three
years
On tab phenytoin 100mg
daily
h/o generalised convulsions
since 1 hour
Patient has lost conscious
since 1 hour
Fever since 3 days and
headache
No vomiting
Past : no diabetes , HTN
Family : none
Personal : none
5. Case 1
Bp : 180/100
CONSCIOUS
Obeys commands
CNS
Speech slurred
RIGHT UMN facial palsy
Other motor is normal
CVS : carotid Bruit
present
Rest normal
Case 2
BP : 200/110
Stuporous
GCS : 6/15
CNS
Paucity of movement in left UL
and LL
Left plantars extensor
Papilloedema
Case 3
BP : 130/80 mm hg
Patient has persistent GTCS
Tongue bite present
Involuntary passage of bowel and
bladder
GRBS : normal
Patient paralysed and intubated
25. DRUGS USED
• Labetalol : 10 mg iv and repeat dose accordingly
• Nicardipine : 5 mg /hr IV infusion
• Enalaprilat : 1.25 mg iv bolus repeated every 15
mins
• Hydralazine : 5-20 mg iv every 30 mins
40. STATUS EPILEPTICUS
DEFINITION
continuous seizure lasting more than 30 min
two or more seizures without full recovery of
consciousness between any of them.
Based on recent understanding of the pathophysiology, it is now
considered that any seizure that lasts more than 5 min probably
needs to be treated as SE.
41. • Status epilepticus (SE) is a common medical emergency
associated with high morbidity, if not mortality.
• Mortality from SE varies from 3–50% in different studies.
• Prolonged SE can lead to cardiac dysrhythmia, metabolic
derangements, autonomic dysfunction, neurogenic pulmonary
edema, hyperthermian,rhabdomyolysis, and pulmonary
aspiration.
• Permanent neurologic damage can occur with prolonged SE.
42.
43. Stage of compensation (< 30 min) Stage of decompensation (> 30 min)
Increased cerebral blood flow Failure of cerebral autoregulation
Cerebral energy requirements
matched by supply of O2 and
glucose
Hypoglycaemia
Increased glucose concentration in
the brain
Hypoxia
Increased catecholamine release Acidosis
Increased cardiac output Hyponatremia
Hypo/hyperkalemia
Disseminated intravascular
Leukocytosis
Falling blood pressure
Falling cardiac output
44. Random blood sugar
Electrolytes - sodium, potassium, calcium, magnesium
Complete blood count
Renal function test, liver function test
Antiepileptic drug level
Arterial blood gas
INVESTIGATIONS
