CASE PRESENTATION

BY Megha

DEMOGRAPHIC DATA
NAME: Mrs. Padmavati AGE: 79 yrs GENDER: Female OCCUPATION: Housewife BUILT: Endomorphic PERSONAL HISTORY: Diabetic and Hypertensive from past 7 yrs

Here is a 79 yrs old female admitted to MAX Saket on 22 Jan 2010 with history of slurring of speech, drowsiness and head rolling since morning. Patient was on Aspirin from last 6 mnths and was clinically stable. CT scan was done which showed CEREBELLAR HAEMATOMA. There was no H/O headache and vomitting. No H/o deviation of gaze and tongue. H/O mild dehydration. Bladder was soft and distended.

HISTORY OF PRESENT ILLNESS

ON EXAMINATION
Patient was drowsy. GCS at the time of admission was E2V2M6. Bilaterally pitting odema of lower limb was present. Muscle power: Rt. U/L and L/L: 5/5 Lt. U/L and L/L: 5/5

HISTORY OF PAST ILLNESS

H/O diabetes and Hypertension from past 7 yrs. H/O Mastectomy for carcinoma breast from past 3 yrs for which chemotherapy was given for 6 mnths. H/O OA knee bilaterally. H/O chronic constipation. H/O # Rt. Tibia 4 yrs. Back for which plating was done.

SURGICAL HISTORY
So patient was Intubated in ICU on CPAP ventilatory support and POSTERIOR FOSSA DECOMPRESSION was done with evacuation of haematoma under G.A. on 23Jan 2010 and on the same day after surgery patient was extubated. Patient was paralysed on ventilatory support following surgery.

COURSE IN THE HOSPITAL

Post operatively patient was doing fine so shifted to ward on 26 Jan 2010. In ward patient developed RESPIRATORY DISTRESS and shifted to NSICU on 28 Jan 2010. On 29 Jan 2010 Rt. FRONTAL OMMAYA RESERVOIR PLACEMENT was done after which patient developed TACHYPNEA. So patient was again intubated and connected to ventilator SIMV. At that time patient was E3VTM6.

 On 30 Jan 2010 CSF drainage was started. And on the same day RT feeding was started. On 1 Jan 2010 patient was maintaining 98% SpO2 on CPAP. On 3 Jan patient was weaned off from the ventilator and was on T piece. On the same day patient was extubated and was maintaining saturation with O2 mask. Patient was on Bipap and Chest physio was 4 hrly. GCS was E4V2M6. Then patient was maintaining 90-92% of saturation on 2 lt. of O2 and GCS has now improved to E4V5M6.

 On 5 Jan Central venous line was inserted through Rt. SCV. Then patient was shifted to wards on 10 Jan. Yesterday RT and Catheter was removed and oral feed was started.

SYSTEM REVIEW
SENSORY: no Sensory loss MOTOR: 1. MMT:B/L UL and LL: 3 2. DTR: a) Biceps jerk: 2+ b/l b) Triceps jerk: 2+b/l c) Knee jerk: 2+b/l d) Ankle jerk: 2+b/l 3. Plantar reflex: 4. ROM: AROM bilaterally full but slightly restricted in Lt. shoulder due to previous fracture and in knee due to OA.

INVESTIGATIONS
CT Scan head: Right cerebellar bleed with ventricular cast. Venous doppler: showed B/L CFV, SFV, Popliteal and Posterior tibial veins are compressible. No evidence of trombosis. ABG showed increased PCO2 level. X-Ray showed Lt. CP angle obscured and lt. pleural effusion.

DIAGNOSIS
HAEMORRHAGIC STROKE

PHYSIOTHERAPY TREARTMENT
Oral suctioning to improve bronchial hygiene. AROM and STRERTCHING Exercises to maintain Joint ROM and mucle flexibility. Bed side sitting to improve trunk balance. Motomed cycling to improve Joint ROM. Standing in O Frame to improve standing balance.