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Young Stroke Cases Linked to Hyperhomocysteinemia

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Stanley Medical College, Department of Medicine
Formation
1  sur  40
Interesting cases of young stroke Prof.S.RAMASAMY’s unit Dr.A.Prakash
Case 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
General examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of CNS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of other system ,[object Object],[object Object],[object Object]
Provisional diagnosis ,[object Object]
CASE 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
General examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of CNS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of other systems ,[object Object],[object Object],[object Object]
Provisional diagnosis ,[object Object]
INVESTIGATIONS INVESTIGATIONS CASE 1 CASE 2 HB 11.8 12.2 TC 7600 6800 DC P66, L33, E1 P71, L26, E2 PLATELET 1.4 LAKS 1.6 LAKS PCV 35% 37% RBC 3.9 MILLION 3.6 MILLION ESR 8/22 10/26 PERIPHERAL SMEAR NORMAL NORMAL
INVESTIGATIONS CASE 1 CASE 2 BLOOD SUGAR 113 MG% 97 UREA 22 25 SR CREATININE 0.8 0.8 Na 134 137 K 3.8 3.8 Cl 106 102 HCO3 23 23 urinalysis SUG NIL, ALB NIL, 1-2 PC SUG NIL, ALB NIL, 2-4 PC PT/APTT 17 (C 12-15), 25 (C 26-39) 16 , 25
LIPID PROFILE CASE 1 CASE 2 TOTAL CHOLESTEROL 173 mg% 185 TRIGLYCERIDES 129 136 HDL 39 42 LDL 99 88 VLDL 35 30
investigations Case 1 Case 2 HIV NR NR RHEUM ATOLOGICAL PROFILE ANA NEG NEG RAF NEG NEG ACLA IgG IgM IgA APLA IgM IgG 2.88 GPL/ml (N <10) 3.04 MPL/ml(N <7) 3.2 APL/ml (N <15) NOT DETECTABLE ( N <15) 3 U/ml (N <15) 5.6 4.8 3.3 NOT DETECTABLE 3.4 u/ml LA NEG NEG
INVESTIGATIONS CASE 1 CASE 2 BLEEDING TIME 3 MIN 4 MIN PROTEIN C 142.1 (n 70-140) 90 PROTEIN S 138.4 (N 60-150) 110 ANTI THROMBIN III 24 (n 22-39MG/DL) 26 HOMOCYSTEINE 126.8 (n 5-16) 150.4
INVESTIGATIONS CASE 1 CASE 2 CAROTID DOPPLER PLAQUE IN LEFT CAROTID BULB NORMAL ECHO NORMAL NORMAL CT BRAIN NORMAL RIGHT SIDED INFARCT MRI BRAIN LEFT MCA INFARCT CXR NAD NAD
OPINION CASE 1 CASE 2 CARDIOLOGY ECHO- N CARDIAC STATUCS NORMAL ECHO –N CARDIAC STATUS NORMAL NEUROLOGY CVA/RIGHT HEMIPLEGIA/ RIGHT UMN FACIAL PALSY/ YOUING STROKE DUE TO HYPERHOMOCYSTENEMIA CVA/LEFT HEMIPARESIS/ LEFT UMN FACIAL PALSY/ YOUNG STROKE DUE OT HYPERHOMOCYSTENEMIA OPHTHALMOLOGY LENS- N, FUNDUS- N, LENS- N, FUNDUS-N
DIAGNOSIS ,[object Object]
Young stroke ,[object Object],[object Object]
Causes of young stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THROMBOPILIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acquired ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to iscemic stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Approac to a Hemorragic stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Homocystinuria ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object]
Other form of homocysteinuria ,[object Object],[object Object],[object Object],[object Object]
pathophysiology ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object]

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Young Stroke Cases Linked to Hyperhomocysteinemia

  • 1. Interesting cases of young stroke Prof.S.RAMASAMY’s unit Dr.A.Prakash
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  • 14. INVESTIGATIONS INVESTIGATIONS CASE 1 CASE 2 HB 11.8 12.2 TC 7600 6800 DC P66, L33, E1 P71, L26, E2 PLATELET 1.4 LAKS 1.6 LAKS PCV 35% 37% RBC 3.9 MILLION 3.6 MILLION ESR 8/22 10/26 PERIPHERAL SMEAR NORMAL NORMAL
  • 15. INVESTIGATIONS CASE 1 CASE 2 BLOOD SUGAR 113 MG% 97 UREA 22 25 SR CREATININE 0.8 0.8 Na 134 137 K 3.8 3.8 Cl 106 102 HCO3 23 23 urinalysis SUG NIL, ALB NIL, 1-2 PC SUG NIL, ALB NIL, 2-4 PC PT/APTT 17 (C 12-15), 25 (C 26-39) 16 , 25
  • 16. LIPID PROFILE CASE 1 CASE 2 TOTAL CHOLESTEROL 173 mg% 185 TRIGLYCERIDES 129 136 HDL 39 42 LDL 99 88 VLDL 35 30
  • 17. investigations Case 1 Case 2 HIV NR NR RHEUM ATOLOGICAL PROFILE ANA NEG NEG RAF NEG NEG ACLA IgG IgM IgA APLA IgM IgG 2.88 GPL/ml (N <10) 3.04 MPL/ml(N <7) 3.2 APL/ml (N <15) NOT DETECTABLE ( N <15) 3 U/ml (N <15) 5.6 4.8 3.3 NOT DETECTABLE 3.4 u/ml LA NEG NEG
  • 18. INVESTIGATIONS CASE 1 CASE 2 BLEEDING TIME 3 MIN 4 MIN PROTEIN C 142.1 (n 70-140) 90 PROTEIN S 138.4 (N 60-150) 110 ANTI THROMBIN III 24 (n 22-39MG/DL) 26 HOMOCYSTEINE 126.8 (n 5-16) 150.4
  • 19. INVESTIGATIONS CASE 1 CASE 2 CAROTID DOPPLER PLAQUE IN LEFT CAROTID BULB NORMAL ECHO NORMAL NORMAL CT BRAIN NORMAL RIGHT SIDED INFARCT MRI BRAIN LEFT MCA INFARCT CXR NAD NAD
  • 20. OPINION CASE 1 CASE 2 CARDIOLOGY ECHO- N CARDIAC STATUCS NORMAL ECHO –N CARDIAC STATUS NORMAL NEUROLOGY CVA/RIGHT HEMIPLEGIA/ RIGHT UMN FACIAL PALSY/ YOUING STROKE DUE TO HYPERHOMOCYSTENEMIA CVA/LEFT HEMIPARESIS/ LEFT UMN FACIAL PALSY/ YOUNG STROKE DUE OT HYPERHOMOCYSTENEMIA OPHTHALMOLOGY LENS- N, FUNDUS- N, LENS- N, FUNDUS-N
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