CEREBROVASCULAR

DISEASE
 PATIENT PROFILE

M.V.
70 years old
Female
Married
San Roque, Zamboanga City
 CHIEF COMPLAINT

DECREASED SENSORIUM
 HISTORY OF PRESENT ILLNESS
Right-handed
Hypertensive (10 years)
Non-Compliant

8 Hours PTA Progressed Admission

Headache Decrease in Sensorium toZCMC
Vomiting Rushed to Local Hospital
Dizziness Managed as CVD
Slurring of Speech Appraised for Intubation and Admission
Left-sided weakness Family Refused (Financial Constraints)
Elevated Blood Pressure (130/100)
Mannitol and Nicardipine Drip
Transferred to ZCMC
PAST MEDICAL HISTORY
Hypertensive (10 years)
Non-Compliant
Denies History of
Diabetes Mellitus
No previous history of stroke or
heart disease.
No history of previous
hospitalizations.
No known allergies to
food or medications.
FAMILY HISTORY
(-) Hypertension

(-) Diabetes Mellitus

(-) Stroke

(-) Seizures

(-) Cancer
 PERSONAL-SOCIAL HISTORY

Diet:
Vices:
Light
No Cigarettes Smoking
A housewife Vegetables and Rice
No Alcoholic Beverage
Extended Family Avoids Oily and
Drinking
Salty Foods
Denies illicit drug use
 PHYSICAL EXAMINATION
The patient is in coma; Pale palpebral
tachypneic lying on a conjunctiva, anisocoric,
stretcher nonreactive to light
Vital Signs
PR: 86 bpm Moist and pale oral
SpO2: mucosa
98% PMI in place,
RR: 28 bpm Normal Heart Rate
BP: and Regular Rhythm
230/170 mmHg
Temp.: 36.1°C
 NEUROLOGIC EXAMINATION
The patient is in coma;
GCS: 3 Increased Muscle Tone
Pupils: No Spontaneous
5-6mm on the right, movement, no
4-5mm on the left; localization nor pulling
Nonreactive to light away from painful
(-) Doll’s Eye Sign stimuli on all
extremities
(+) Corneal Reflex No Nuchal Rigidity,
No Kernig’s,
(+) Babinski Reflex No Brudzinski’s Signs
CLINICAL DIAGNOSIS

Cerebrovascular
Disease
Probably Bleed
Right Basal Ganglia
 CLINICAL DIAGNOSIS
UPPER MOTOR NEURON LESION
 CLINICAL DIAGNOSIS
SIRIRAJ STROKE SCORE
CONCEPT MAP
 DIAGNOSIS CERTAINTY
Diagnosis Certainty Basis for Certainty Treatment Modality
Cerebro- 90% History of: Medical
vascular  Sudden onset headache Management the
Disease  Vomiting increased blood
 Dizziness pressure, resolution
 Slurring of speech
 Left-sided weakness of incracranial
Physical Examination findings: pressure and edema
 GCS=3 Surgical
 Blood pressure: 230/170 mmHg management for
 Anisocoric pupils
 (-) Doll’s eye removal of
 Increased muscle tone hematoma
 (+) babinksy left
 PARACLINICALS
Diagnostic Procedure Benefit

CT Scan of the Brain-Plain This would provide evidence on the nature of the
stroke/CVD, the exact location, size of affected area

12 Leads Electrocardiogram This would evaluate the cardiac performance and

detect any arrhythmias.
This would also help identify risk of developing
cardiac arrhythmias that may lead to poor
prognosis
PARACLINICALS
 MANAGEMENT
Treatment Benefit
Modality
Intubation This protects the airway of patients who
have poor airway protection such as patient
in coma
Hyperventilation To help in decreasing intracranial pressure
Beta blockers/ This would lower the patient’s blood
vasodilators pressure, may reduce bleeding
Nicardipine Drip This would lower the patient’s blood
pressure, may reduce bleeding,
Mannitol Drip Diuretic that can cross the blood brain
barrier and help reduce cerebral edema
Risk
Fever and soreness at
injection site, thrombosis
 
May cause hypotension and
decrease cerebral perfusion
May cause hypotension and
decrease cerebral perfusion
Pulmonary congestion,
Electrolyte imbalance
 MANAGEMENT
Treatment Modality Benefit Risk
Hematoma Decreases the mass effect and Bleeding
Evacuation cytotoxic effect of hematoma. Surgical site infection
NGT Insertion For Fluid and Nutrition  
Retained Urinary For Fluid Output monitoring Risk for Urinary Tract
Catheter Insertion Infection
Omeprazole To decrease the production of gastric  
acid that may cause gastritis/PUD
 ACTUAL MANAGEMENT

Procedure Patient Outcome

Supportive Management due to Patient was monitored regularly,
Family’s request for Do-Not- transferred to ICU-ER
Resuscitate and refusal for
Intubation However, patient’s sensorium did not
improve despite medical treatment
Patient expired hours after admission
PREVENTION AND HEALTH PROMOTION

Hypertension :
Compliance To Maintenance Medications
Exercise
Proper Diet
Blood Pressure Monitoring
Diet:
Low Salt
Low Fat Diet

Eliminate:
Alcohol Drinking And Smoking