Thalamic

infract/Stroke
Presentation by:
Anirudha PV
DSU15PD0003
 Definition
• Thalamic infract is also a type of stroke which is
mainly seen in Thalamus region of brain.
• This is a lacunar type of stroke which refers to stroke
in a deep part of the brain.
 Patient details
• Name: ABC
• IP number: 0057744
• DOA: 07/09/2018
• DOD: 12/09/2018
• Age: 65 yrs
• Sex: Male
• Weight: 65 Kgs
 Subjective data
Patient has chief comlaints such as -
• C/O upper limb and lower limb weakness since 2pm
• C/O inability to stand or walk since 2pm
 patient have the K/C/O of DM type 2 and he is no regular
medication.
he has the medication history of TAB. Voglibose
His physical examination shows that the patient is moderately
built, concious, well oriented to surroundigs, time and person.
 Objective data
vital signs:
BP: 170/90
PR: 88 bpm
RR: 14 cpm
Temperature: Afebrile.
 systemic examination of CNS shows folloing data
motor exam: UL- 4/5(R) 5/5(L)
LL- 4/5(R) 5/5(L)
Sensory exam: B/L equal UL/LL
provisional diagnosis: Thalamic infract
Radiographic data: MRI of brain(stroke
protocol)
• Impresson: Thalamic infract
Laboratory data:
Parameter value Normal value
PTT (sec) 21.3 60-70
aPTT(sec) 12.8 30-40
 Assesment
• based on subjective evidence such as C/O upper limb
and lower limb weakness and unable to stand up or
walk, K/C/O DM type 2 and the objective evidence
such as MRI brain(stroke protocol) showed thalamic
infract and abnormal values(lowered values) of PTT
and aPTT. Thus the patient is diagnosed with
“Thalamic infract(stroke)” and “DM type 2”
 Goals of therapy
The main important is to treat Thalamic infract.
To treat DM type 2.
To reduce the days of stay in hospital.
 To rduce the need for hospitalization.
 Therapy
Brand name Generic name dose /frequency 1 2 3 4
INJ. COLIHENZ Citicoline 500mg IV BD    
INJ. STROCIT Citicoline 500mg in 100ml NS IV 
INJ. PANTOP pantoprazole 40mg IV OD   
INJ.H ACTRAPID Soluble insulin Acc to sliding scale  
INJ.ONDANSETRON ondansetron 40mg IV  
INJ. CLEXANE enoxaparin 40mg S/C BD    stop
INJ. R JET rabeprazole 20mg IV 1-0-1 
T.CLOPILET Clopidogrel +Aspirin 150mg STAT    stop

T.ROSUVAS rosuvastatin 20mg STAT   

TAB. ISTAMET SItagliptin+ Metformin 50/500 P/O 1-0-1 
T. VOGLITOR Voglibose 0.3 mg 1-0-1   
T.GLYCOMET GP 1 P/O 1-0-0   
 Patient progress
• Day 1:
HR- 88 bpm BP- 170/90 mmHg RR- 14cpm GRBS- 229 mg/dl
Right side weakness and adviced for MRI of brain(stroke protocol).
• Day 2:
Mild worsening despite full anticoagulant. BP- 150/80 mmHg adviced to
increase CLEXANE 60 mg S/C BD and adviced for physiotherapy for mobilize to
chair.
Right side hemiparasis.
• Day 3:
weakness stable, shifted to ward. IV fluids 75 ml/hr
BP- 133/71 mmHg.
 Goals achieved
• weakness improved.
• patients blood suger was under control
• slight mobilization was possible.
• Blood pressure was reducing on its own.
 Planning
Suggestion to physician:
There are some major ADR in the therapy chart:
1. Aspirin and Enoxaprin:
The combination of these two drugs may cause bleeding disorders.
dose should be monitored for combining these drugs.
2. Enoxaparin and Clopidogrel:
even this combination has the high risk of causing bleeding disorders.
 Advice to patient
Patient counselling
• Disease related:
The condition is also called as Stroke and this was caused due to blood
coagulation in deeper part of brain and that was the main reason for weakness in
limbs and unable to stand or move.
• Drugs related:
1.citicoline was given to treat stroke
and many anticoagulants were administered to avoid coagulation.
2. In case of any adverse are seen directly dont stop the drug but consult the
doctor and discuss with him.
 Life style modification
• The disease can be controlled to certain extent even by combing life
style changes with the therapy.
• Healthy food habits should be combined with regular simple exercises
will help lower and control the blood choesterol levels.
• comsume fresh leafy vegetables, whole grains, pulses and fresh
vegetables.
• Stop alcohol and quit smoking if those habits are present.