Details of the Patient :
Patient’s Name : Ayub Shaik
Patient’s Age : 49
Patient’s Gender : Male
Attending Chief Physician :
Dr. Mohana Rao Patibandla, MCh (NIMS), iFAANS(USA), FESBSS (USA), FPNS (UCD, USA), FEVNS (UVA, USA), FNSORS (UVA, USA), FMINS (OSU, USA), FPNS (UCD, USA)
Symptoms shown by the Patient :
Mr. Ayub Shaik visited Dr Rao’s Hospital which is the best neurology hospital in Guntur with the following:
Treatment Provided to the Patient :
An Overview of the Case :
Mr. Shaik Ayub is a 49 y.o. male with new-onset right hemiparesis and aphasia of one-hour duration and he was here for further management. He was hypertensive with BP 190/115 mm of Hg and was controlled with labetalol slow IV push injection. He was given Tenekeptlase 50 mg and then He was taken to the CT scan and angiogram with the intent of the mechanical thrombectomy.
The patient was admitted to the ICU and was attended by Dr. Mohana Rao, who is considered as the best neurosurgeon in Andhra Pradesh. When he was admitted to the hospital his GCS was 13.
For surgery, the patient was placed supine on the angiographic table, and the right groin was prepped and draped in the usual sterile manner. The skin and subcutaneous tissues were anesthetized with 0.25% bupivacaine. Using a 19 G needle the right common femoral artery was punctured and cannulated under ultrasound guidance and a 5 French arterial sheath was placed over a guidewire. The sheath was attached to continuous heparinized saline flush. A 5F Bernstein catheter was placed through the sheath and advanced over a Terumo guidewire into the aortic arch. Selective catheterization of the following blood vessels was performed (see below).
At the end of the procedure, after verifying that the sheath entered in an appropriate place, the sheath was removed along with 20 min manual compression and hemostasis was achieved without difficulty.
The patient was admitted to the ICU and immediately did the cerebral angiogram following the tenecteplase injection. The recovery was uncomplicated and was observed for the recurrent stroke of the left hemisphere and there was not another episode. He improved to his baseline with normalization of the power on the right side and aphasia was reverted with normal speech, no more deficits in two hours.
On postoperative day #1, the patient was seen by the Physical Therapy and Occupational Therapy Services and found to have no further inpatient needs. Currently vital signs and laboratory examination were unremarkable with counting fingers at 6 meters and able to clearly see the objects and identifying the colors. Examination demonstrated full strength and sensation. The patient was having appropriate bowel movements and bladder function. The incision was clean, dry, and intact. Therefore, with pain well-controlled and actively taking p.o. intake, the patient was considered stable for discharge.
Post Operative medication :
- Tab. Aspirin plus Clopidogril OD
- Tab. Aceclofenac and Caffeine TID for a week
- Tab. Rabeprazole 20 and Levosulpiride 30 mg Once daily before breakfast
- Cap. Bentop plus Once daily
- Cap. Gabapentin 300 mg and Methylcobalamin 500 two times daily
- Tab. Atorvastatin 40 mg night timed
- Tab. Telmesartan 40 mg OD
- FreeLax Syrup as needed for a bowel motion
- Please take plenty of fluids and continue antihypertensives to prevent recurrent strokes.
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