20 year female with h/o sudden onset right hemiplegia with intact speech for last 5 days. There is no h/o any loss of consciousness, headache, vomiting or seizures. There was no history in the past and there is no family history. No h/o any drug intake like OCPs, No h/o breathlesness, palpitations. O/E GPE was normal and there were no xanthomas or xanthalesmas, Vitally there is radioradial delay on left side, with weak pulses on left upper limb. there is no radiofemoral delay. there were also weak pulses of left carotid system, BP was different on both upper limbs. Rt. upper limb 120/60mmhg, left side 80/60mmhg both in supine and lying position. bruite was audible in left carotid and subclivian artery. ON neurological examination GCS was normal, Speech normal, HMF intact, Cranial nerves Rt. 7th UMN type weakness, Hypotonia with power 0/5 on right side, reflexes +1 on right side,Rt. planter was upgoing. CT brain done showing left basal ganglia infarct, baseline investigation normal, Lipid profile normal, BSL normal, Echo and ECG normal, Carotid dopplor showing 70% stenosis on left side......Whats the differential diagnosis, how will u proceed and how will u manage.
Posted on: Sun, 30 Mar 2014 19:23:33 +0000
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