CASE PRESENTATION ON

HEMIPARESIS, FACIAL PALSY AND

MCA INFARCT
UNDER THE GUIDANCE OF: DR. MARYAM
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY PRACTICE

PRESENTED BY: SALMA WAJID

ROLL NO: 170722882013
PHARM-D 2ND YEAR
INTRODUCTION
HEMIPARESIS:
• Hemiparesis is one-sided muscle weakness. It happens because of
disruptions in your brain, spinal cord or the nerves that connect to the
affected muscles.
• Hemiparesis can sometimes be confused with hemiplegia. Both
conditions can occur after a stroke. Hemiplegia, however, is paralysis
on one side of the body, making it difficult to move the affected side
at all. You may lose bladder control and have trouble speaking,
swallowing, and even breathing. Hemiparesis, on the other hand,
involves weakness rather than paralysis.
CAUSES:
1. Stroke: It is the most common cause of hemiparesis. Most strokes
happen when the supply of fresh oxygen is cut off to a portion of
the brain, causing brain cells to die[ known as INFARCT]. When
areas of the brain that are responsible for movement and strength
are damaged, it can lead to hemiparesis.
2. Brain damage due to trauma or head injuries.
3. Brain tumors caused by cancer.
4. Certain diseases: such as cerebral palsy, multiple sclerosis and some
cancers.
FACIAL PALSY:
• Facial paralysis is the inability to move the muscles on one or both
sides of your face due to nerve damage.
• Causes of UMN Facial palsy:
1. Stroke
2. Tumour
3. Trauma
4. Infection
5. Auto immune diseases such as Multiple sclerosis.
PATHOPHYSIOLOGY OF HEMIPARESIS:
SYMPTOMS:

• Weakness.
• Tingling or numbing sensation
• Difficulty walking.
• Loss of balance.
• Muscle fatigue.
• Difficulty with coordination.
• Inability to grasp objects.
 RISK FACTORS:
• Age
• Lack of exercise
• Hypertension
• Uncontrolled diabetes
• High cholesterol
• Smoking
• Obesity
COMPLICATIONS
• Because hemiparesis is a possible stroke symptom, the risks of not treating it can be high. In the
worst cases, it can result in permanent brain damage, paralysis, loss of abilities or even death.
TREATMENT:
• The treatments for hemiparesis depend on the underlying cause. Some of these conditions are
treatable or even curable. Others may get better on their own. Unfortunately, many of these
conditions (such as spinal cord or traumatic brain injuries) can permanently damage affected
parts of your nervous system. In these cases, the hemiparesis won’t go away, although it may
improve to some degree. Treatment plan will likely include a combination of:
• physical therapy
• occupational therapy
• rehabilitation therapy
• mental health therapy
PATIENT DEMOGRAPHIC PROFILE
AGE GENDER ALLERGIES DEPARTMENT
48Y FEMALE NONE NEUROLOGY

Chief complaints:
• Trouble speaking and understanding since one day. VITALS:
• Right and left upper and lower limb weakness. BP: 140/90 mm Hg
PR: 88 bpm
PMHx: HTN+, DM+, No history of asthma, Tb, hypo/hyperthyroidism. RR: 17 b/m
Temp: 98.5 F
PHx: No history of headache, vomiting on onset. GRBS: 365 mg/dl

FMHx: Not significant

PROVISIONAL DIAGNOSIS:
• The patient was diagnosed with Right Hemiparesis along with Right UMN facial palsy and left
MCA infarct.
MEDICATION CHART
CASE TIMELINE
MEDICATION DOSE FREQUENCY ROA
 DAY 1: Inj. Pantop 40mg OD IV
 C/O: Inj. Zofer 4mg OD IV
Trouble speaking and Inj. Clexane 40mg OD S/C
understanding since one day.
Right and left upper and lower Inj. Optineuron 1amp OD IV
limb weakness. Inj. Strocit 500mg BD IV
 O/E: C/C/C
Inj. Nootropil 1.5gm BD IV
GCS: E4V1M6
 VITALS: Tab. Ecosprin 150mg OD PO
BP: 140/90 mm Hg Tab. Atorvas 80mg OD PO
PR: 88 bpm
Tab. Telma 40mg OD PO
RR:17 b/m
Temp:98.5 F HAI 8 units TID S/C
GRBS: 365 mg/dl
 DAY 2:
 C/O: No fresh complaints VITALS:
 O/E: C/C/C BP: 140/80 mm Hg
PR: 72 bpm
 ADV: RR: 20 b/m
Temp: afebrile
Physiotherapy
GRBS: 283 mg/dl
IVF NS at the rate of 20ml/hr
S/E:
CVS: S1S2+
MEDICATION CHART RS: BAE+
CST P/A: Soft
 DAY 3:
VITALS:
 C/O: No fresh complaints BP: 140/90 mm Hg
 O/E: Patient was stable, Aphasia improved. PR: 98 bpm
RR:18 b/m
 ADV: Temp:98.6 F
GRBS: 249 mg/dl
Physiotherapy
S/E:
IVF NS at the rate of 20ml/hr. CVS: S1S2+
Diabetic soft diet with low salt advised. RS: BAE+
P/A: Soft
MEDICATION CHART
CST+TAB TONACT-F OD
+TAB GLYNAMIC-M2 BD – TAB ATORVAS
 DAY 4:
 C/O: Slurred speech VITALS:
BP: 140/90 mm Hg
 O/E: Dysarthria+ PR: 87 bpm
RR:18 b/m
 ADV: Temp:98 F
GRBS: 221 mg/dl
Physiotherapy
IVF NS at the rate of 20ml/hr. S/E:
CVS: S1S2+
RS: BAE+
MEDICATION CHART P/A: Soft
CST+TAB VILDARAY-M 50/500mg OD
 DAY 5
 C/O: Decreased sleep VITALS:
BP: 140/90 mm Hg
 O/E: patient was C/C/C PR: 86 bpm
RR:19 b/m
 ADV: Temp:98.6 F
GRBS: 120 mg/dl
Physiotherapy
IVF NS at the rate of 20ml/hr. S/E:
CVS: S1S2+
RS: BAE+
MEDICATION CHART
P/A: Soft
CST+TAB LIBRIUM 10mg H/S
 DAY 6
VITALS:
 C/O: No fresh complaints BP: 140/80 mm Hg
 O/E: patient was stable, Dysarthria+ PR: 91 bpm
RR:19 b/m
 ADV: Temp: 97.6 F
GRBS: 170 mg/dl
Physiotherapy
S/E:
IVF NS at the rate of 20ml/hr. CVS: S1S2+
RS: BAE+
MEDICATION CHART
P/A: Soft
CST
LAB INVESTIGATIONS
LIPID PROFILE TEST
Parameter Result Normal value
Total cholesterol 174 mg/dl 125-200
Triglycerides 550 mg/dl 25-160
HDL cholesterol 27 mg/dl 60
LDL cholesterol 37 mg/dl Less than 100
VLDL cholesterol 110 mg/dl Less than 36

RANDOM BLOOD SUGAR

Parameter Result Normal range

Random blood sugar 298 mg/dl 60-150
 FBS AND PLBS
PARAMETER RESULT NORMAL RANGE
FBS 286 mg/dl 70-100
PLBS 299 mg/dl 90-140

SERUM ELECTROLYTES
PARAMETER RESULT NORMAL RANGE
Na+ 140 mmol/L 136-145
K+ 3.9 mmol/L 3.5-5
CL- 102 mmol/L 95-105
 RFT [ RENAL FUNCTION TEST]
PARAMETER RESULT NORMAL RANGE
Urea 30 mg/dl 10-45
Creatinine 0.6 mg/dl 0.6-1.5
Uric acid 2.0 mg/dl 3.5-7

LFT [LIVER FUNCTION TEST]

PARAMETER RESULT NORMAL RANGE
Total Protein 7.4 gm/dl 6-7.5
Serum Albumin 4.2 g/dl 3.5-5
Total Bilirubin 0.5 mg/dl 0.3-1.2
Conjugated Bilirubin 0.2 mg/dl upto 0.25
SGOT 11 U/L 5-45
SGPT 10 U/L 5-45
Serum Alkaline Phosphatase 128 U/L 30-120
 CBP [COMPLETE BLOOD PICTURE]
PARAMETER RESULT NORMAL RANGE
Haemoglobin 14.0 gm/dl 11-15
RBC 4.9 million/cumm 3.8-5.0
WBC 7900 cumm 4000-11000
Platelets 2.0 lakhs/cumm 1.5-4.5

BIOCHEMISTRY

PARAMETER RESULT NORMAL RANGE

HbA1c 10.2% Non-Diabetic: less than 6.0%
 TREATMENT CHART

MEDICATION GENERIC NAME DOSE FREQUENCY ROA INDICATION

Inj. Pantop Pantoprazole 40mg OD IV Antacid

Inj. Zofer Ondansetron 4mg OD IV Antiemetic
Inj. Clexane Enoxaparin 40mg OD S/C Anticoagulant
Inj. Optineuron Thiamine + Vit b6 1amp OD IV Vitamin supplement
Inj. Strocit Citicoline 500mg BD IV Used to treat stroke
Inj. Nootropil Piracetam 1.5gm BD IV Used to treat dyslexia, stroke and
brain injury
MEDICATION GENERIC NAME DOSE FREQUENCY ROA INDICATION
Tab Ecosprin Aspirin 150mg OD PO Antiplatelet
Tab Librium Chlordiazepoxide 10mg OD H/S Sedative and Hypnotic
Tab Telma Telmisartan 40mg OD PO Used to treat high blood
pressure
HAI (Human Actrapid Human Insulin 3 units TID S/C Antidiabetic
Injection)
Tab Tonact-F Atorvastatin + 1 tablet OD PO Used to treat high cholesterol
Vit b3
Tab Glynamic-M2 Glimepiride+ 1 tablet BD PO Antidiabetic
Metformin
Tab Vildaray-M Metformin+ 50/500 mg OD PO Antidiabetic
Vildagliptin
SOAP FORMAT
• SUBJECTIVE:
A 48 year old woman came to ER with complaints of trouble in speaking
or understanding since one day.

• PMHx: HTN+, DM+, No history of asthma, Tb, hypo/hyperthyroidism.

• PHx: No history of headache, vomiting on onset.
• FMHx: Not significant.
OBJECTIVE:
• Lab investigations revealed abnormal blood sugar and HbA1C levels.

• Moreover, the triglyceride levels were also found to be much higher

than normal.

• MRI report revealed infarct in the region of brain supplied by the

Middle Cerebral Artery.
ASSESSMENT
• According to the subjective and objective data, the patient was diagnosed with Left MCA
Infarct, Right Hemiparesis and Right UMN facial palsy.

• PROBLEM 1: Stroke
MEDICAMENT: Strocit, Nootropil

• PROBLEM 2: Blood clot formation

Medicament: Clexane, Ecosprin

• PROBLEM 3: Vitamin deficiency

MEDICAMENT: Optineuron
• PROBLEM 4: Insomnia
MEDICAMENT: Librium

• PROBLEM 5: Diabetes
MEDICAMENT: HAI, Glynamic-M2, Vildaray

• PROBLEM 6: Hypercholesterolemia
MEDICAMENT: Tonact-f
PLAN
• INJ. PANTOP/40mg/OD/IV
• INJ. ZOFER/4mg/OD/IV
• INJ. CLEXANE/40mg/OD/S/C
• INJ. OPTINEURON/1amp/OD/IV
• INJ. STROCIT/500mg/BD/IV
• INJ. NOOTROPIL/1.5gm/BD/IV
• TAB. ECOSPRIN/150mg/OD/PO
• TAB. LIBRIUM/10mg/OD/H/S
• TAB. TELMA/40mg/OD/PO
• INJ. HAI/3 UNITS/TID/S/C
• TAB. TONACT-F/1 TABLET/OD/PO
• TAB. GLYNAMIC-M2/1 TABLET/BD/PO
• TAB. VILDARAY-M/50/500MG/OD/PO
PHARMACIST INTERVENTION:
• ASPIRIN + ENOXAPARIN SODIUM
Severity : Major
Interaction : Concurrent use of ASPIRIN and ANTICOAGULANTS may result in increased risk
of bleeding.
Method to minimize: Promptly evaluate any signs or symptoms of blood loss that occur in a
patient treated concomitantly.

• ASPIRIN + GLIMEPIRIDE
Severity : Major
Interaction : Concurrent use of ASPIRIN and ORAL HYPOGLYCEMICS may result in increased
risk of hypoglycaemia.
Method to minimize : Monitor blood sugar carefully if concomitant use is required.
• ASPIRIN + METFORMIN HYDROCHLORIDE
Severity : Major
Interaction : Concurrent use of ASPIRIN and ORAL HYPOGLYCEMICS may result in increased
risk of hypoglycemia.
Method to minimize : Monitor blood sugar carefully if concomitant use is required .

• GLIMEPIRIDE + METFORMIN HYDROCHLORIDE

Severity : Major
Interaction : Concurrent use of METFORMIN and INSULIN SECRETAGOGUES may result in an
increased risk of hypoglycemia.
Method to minimize: If co-administered , lower dosages of the insulin secretagogue may be
required to reduce the risk of hypoglycemia .
PATIENT COUNSELLING:
REGARDING DISEASE :
• Hemiparesis is a common after effect of
stroke that causes weakness on one side of
the body.
• This one sided weakness can limit your
movement and affect all basic activities,
such as dressing, eating and walking.
• The most common cause of Hemiparesis is
stroke.
REGARDING MEDICATIONS:
1. Patient was counselled regarding the medication and purpose of medication was also
explained.
2. Medicaments should be taken on time and if missed do not double the dose.
3. ASPIRIN interacts with GLIMEPIRIDE as well as METFORMIN HYDROCHLORIDE. So to prevent
this, the administration of these drugs should be done by giving time intervals between them.

REGARDING LIFESTYLE MODIFICATIONS:

1. Eat a balance diet.
2. Manage your health conditions.
3. Don’t ignore infections.
4. Wear safety equipment.
THANKYO
U