HEMIPLEGIA - Clinical case presentation
ฝัง
- เผยแพร่เมื่อ 10 ก.พ. 2025
- #ComprehensiveClinicalClass
Hemiplegia Clinical case presentation by Ms.Rekha, 4th year MBBS, BGSGIMS, Bengaluru.
Mentor:
Dr. Archith Boloor,
Additional Professor,
KMC, Mangalore.
PPT:-
drive.google.c...
Time stamps:
01:00 History
01:17:00 Physical Examination
01:31:13 Higher mental function Examination
01:32:25 Cranial Merves Examination
01:41:15 Diagnosis
01:43:53 Management
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Before watching the video completely, i want to take a minute to appreciate Ms. Rekha. You are you going to be a great doctor. You almost answered every question. I am soo happy for you.
I liked Dr. Baloor's way of questioning and calmness in explaining. Very good for an examinee. Good presentation from the student's end.
What is the dofference in progression of hemorrhagic and thrombotic stroke?
@@sakshikumari7349The difference is time of occurance..progession almost looks similar.. Also can be differentiated on symptoms headache, vomiting in hemorrhagic stroke is classical
Salute to the girl she is very knowledgeable
It is a very good clinical case presentation and discussion. I am a family practitioner, (practising)76y.I appreciate the student' presentation .I learnt a lot about hemiplegia, how to diagnose ischemic haemorrhagic and embolic strokes. I wish I were your student. Thanks
Mam almost answered all questions…. 😱😱😱
😱😱😱
That's bcoz she already heard sir's class
@@dryash866 which class??
Namaste sadguru 😁
Easy way to remember: Life of PAI(plasminogen Activator Inhibitor) begins in the morning! Cause of increased thrombotic strokes/MI in the early morning hours
❤
Hands down the best case presentation i watched ever in my life
Mesmerising presentation and very insightful and indepth discussion by Bolloor sir who is a gifted teacher. Voice of presenter is very clear and soothing type. @
Yes boss 👌
1:07:43 CADASIL is Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
Early morning presentation of thrombotic stroke is due to Cortisol rise in body which cause vasoconstriction leading to Stroke is what a professor in my college had said
great teacher ..... teaching from heart....... best source for clinical exam prepration ....... true name of teacher
1:12:11 stroke mimics
SOL
Migraine
Meningitis
Hypo/Hyperglycemia
Todd's paralysis
24-7 hr in Todd's
Very useful. Plus Ms Rekha did brilliantly.
Admin, succeeded in maintaining the communication.......good quality audio and video this time, weldone Sir.
Thank you so much entire team, great efforts 🙏🙏🙏🙏, thank you so much sir for your valuable time....
Really an amazing and fruitful presentation . I admire the way of presenting the case as well as the questions and discussions. God bless you both.
Thanks sir for explaining the concept in a very nice way ❤
Thank you so much Archit sir .....very comprehensive
Wow What a Case Presentation 🎉Dr Boolor Sir is Amazing🤩
Must watch !!
Wow ! Very Well presneted for a UG 👌🏼
1:02:08 htn
Ischemic > hemorrhagic but both possible
Lacunar infarcts very small vessels .3-1.5 cm size
Pure motor
Or pure sensory
Or hemiballismus
Lacunar infarcts
Post limb of IC >> genu, thalamus
Doubt..Deviated face towards ? 27:50
Umn cl
Lmn il
Brainstem lmn opposite side of stroke
Above cortical on side of stroke
Beautiful🎉❤
sir pls bring the case presentation over parkinsonism with archit baloor sir ... the way he explain helped me a lot while my case presentation 💓💓💓
Thank you very much archit sir 🙏
Nice presentation n discussion 👍
1:26:47 ischemic stroke don't reduce bp achanak se as penumbra ko bachata hai
Redce slowly While hemorrhagic stroke eg if bleed..reduce
Dysarthria or aphasia....
Facial nerve...lips P B AFFECTED...
Linguals ..t th d dh
9 10 for kha gha
Aphasia mei sb kuchh involved....not easily common in internal capsule
34:06 word output
Females more
Thanks❤... Archit sir is as always great
She doesn't look like undergraduate
Amazing discussion
Such an amazing discussion ❤️
1:18:20 relevance of pulse in stroke...irregularly regular pulse in a fib
Raised ict decrease?? in pulse
Bradycardia cushings reflex
Arterial wall palpable and thickened in severe atherosclerosis
Peripheral pulses absent feeble in vascular diseases and
variuous cardiac diseases... valvular ds
AR - WATERHAMMER
AS - ANACROTIC pulsus parvus et tardus
Pulse mein rhythm volume character and arterial wall ke ilaawa also auscutate CAROTID bruit
Also for posterior circulation ... vertebral artery(from subclavian 1st part) mei check bruit...straight line from medial end of clavicle and mastoid... surface anat. Of vertebral artery and arising from there it goes up thru transverse foramen of vertebra
No bruit only rules out ...possible ke complete occlusion ho jayega
No bruit in complete occlusion....bruit in 30-70 percent occlusion 1:25:23
28:30 aphasia- language problem - cortical localisation? Or slurring of sleep(dysarthria)- speech problem/ articulation problem - localises to brainstem
1:28:40 increased ict pe decreased RR
+ Certain soecific patterns eg cheyne stomes etc
Discussion has been thorough and so very valuable.
Doing a great job sir 🙏🙏🙏 keep posting S
Help a lot of solving doubts
Nice discussion sir ma'am give aprrox all the answer
24:18 proximal and distal UL and LL ke liye...hair combing, holding glass, sqatting and gripping slipper
So much helpful sir❤❤❤❤
38:50 broca vs subcortical aphasia
repetition intact then brocas area intact
If gone fhe. Sub cortical
Great discussion!
Thankyou sir. 😊
1:28:04 watershed infarct- in multiple areas
Ms Rekha answered everything but lill anatomical basics and surface anatomy she needs to know ... Thats it
Greatest case and discussion❤nice explanation sir…the only hmm I like after Shreya
Ghoshal 😅
Really good! Gonna prepare for my case based on this 👍🏽
😅
1:15:08 do not forget autonomic fn...asked for lateral medullary synd
Horners mainly
Cervical cord inv(rarely)
1:16:47 xanthomas etc for metabolic synd,
1:32:23 in fundoscopy subhyaloid space- boat shaped...dursen's syndrome
1:35:57 Spasticity not rigidity bcz only antigravity muscles i.e flexors in upper limb and extensors in lower limb affected
Rigidity all muscles affected
Spasticity has clonus+ babinsky sign
Spasticity is velocity dependent ...vel increase krne pr spasticity also increases whereasd rigidity increases
Spasticity is Clasp knife spasticity pattern while rigidity is lead pipe pattern
1:09:56 young female ho toask menstrual history
Ocp
Apla syndrome history etc
LOC hemorrhagic or large infarct
Cortex and RAS (brainstem ) involved in alertness consciousness
Why UMN lesions have distal muscle weakness first any logic?
Because if UMN supplying proximal muscle involved ,then patient will have only proximal muscle weakness…..
Kuddos to the presenter calm cool and super intelligent
Omg is it undergraduate student who presented
Sir in my experience I witnessed in icu (I work as a duty doctor now as well) a few traumatic SAH.
Traumatic SAH s are fairly common
Very useful 👍
27:21 LMN IL side of weakness../ opposite side of stroke...brainstem
Umn cl side of weakness/ cortical lesion same side of stroke
???? Crossed or uncrossed hemiplegia
V nice 👍
1:41:49 3 and below power u can't do cerebellar
Thank you sir
But if brocas 39:04 kaha yahan then cortex involve...butttt...., cortical can not have dense hemiplegia as in this patieny
Very good
Timing
Deficit at onset
Progression
For type of stroke based on history
Is it left side or right side umnl at 1:35:05
1:44:44 treatment
Mechanism of fever in venous strokes and why fever doesn’t happen in arterial stroke??
No deliveryof inflammatory mediators in case of arterial stroke
Mangalore 🔥
1:26 speech
40:14 no aphasia in IC 😊
How sensory components intact if internal capsule involved
In umn distal weakness start first eg in fingers
Well done sir...thanks u..
Aphasia localises to cortex dosorder of language
Dysarthria articulation affected brainstem or any cranial nerve eg 7, 9 , 10 , 12
Facial nerve(since face dev) involved therefore PPPPP wali sound lips inv.. in sounds mei dysarthria
Iç lesion not produces aphasia ...therefore 2 lesions
Word out put females more
1:08:54 pure veg b12 def homocysteiimia
Hyper homocysteine
Alcohol cocaine smoking
Std like hiv may have
Can we have a case presentation like this on paraplegia also sir regarding the approach and all 🙏
we already have many a discussion videos on paraplegia..kindly check
What is the difference in progression of thrombotic & hemorhagic stroke? Can it be differentiated clinically?
Both have almost same progression.. But vary in time of occurance.. Symptom wise hemorrhagic will be have raised ict with Heachache, vomiting
36:42 telegraphic speech in broca...classically bolega hi nhi in broca,
Agr bola bhi to set no. Of codes mein hi bol payega..eg yes no. Ok
25:08 umn disease like stroke...have distal first affected
Why posterior limb of internal capsule stroke localization
Kadak,🤗🤗
Don’t be like layman man…
Using India language in no way makes u layman .. knowledge is imp
Temp high bad prognosis
Hyper pyrexia in endocarditis , pontine lesions,meningitis, venous strokes eg due to DVT
Edh or sdh hematoma may lead to hemiplegia kind of symptoms
Can someone explain the planter response why is it like that?
Umn lesion first has distal motor weakness
Sir provisional diagnosis i think it is left sided umn facial palsy as on examination we have loss of nasolabial folds on right side so contralateral will be left facial palsy
i also made the same confusion during my models. if the patient has loss of nasolabial fold on the right side and deviation of angle of mouth to the left. then we call it right sided facial palsy only but the lesion is on the left side (if its an UMN) . its quite tricky but we have to be careful while answering
Raised ict in hemorrhagic, or large thrombotic
Sir… Is she an undergraduate.. 🙏my namaste to the UG case presenting… I am 76 y.
👌
Internal capsule involved, so why hemiparesis and not hemiplegia?
Don't say hemiplegia until zero power
Only lower part of face affected therefore UMN type
👏👏
Chassignac tubercle
Who's the girl presenting the case??
🙏🙏tqsm
Here, the history of deviation of angle of mouth as taken, will be right sided and not left sided.... M i right?
Tia r/o ke liye transient loss of vison(pertaining to anterior circulation carotid srtery-amaurosis fugax,..opthalmoc art inv.>>> monoparesis, sensory loss aphasia
Or posterior circulation vertebrobasal...weakness in iol(cranial nerves) , vertigo (ataxia) hiccoughs
If More than 2 tia ..rx. put on anti platelets
Tia indicstes ischemic stroke....can be thrombotic or embolic stroke
Tia rules out hemorrhagic stroke
Now embolic recurrent short lasting deficit different features each time
Thrombotic stroke longer duration in bw...vessel is narrowed ..same vessel damaged..same features each time
Tia - 7 times increased risk of getting stroke
60-70% will get a stroke
Majority will get. A stroke in first week...rest in first 3 months
Abcd2 score
No history of seizures r/o cortical inv
Meningitis fever vascular inflammation...eg tb (chronic).. may cause stroke??????
Involuntary inv basal ganglia
No urinary and fecal incontinence...seizures...as present in post ictal
LOS
IC c/l
Lateral medullary synd
Thalamic - burning pain
LOB -Cerebellar stroke
Also commentrd if power normal otherwise power ki wjh se bhi
Woww 🔥
Umn type of facial nerve palsy