Title : You should not start young: A case of a 25-year old presenting with ischemic infarcts and a chronic intracranial hemorrhage
Abstract:
Patient J.Y, a 25 year old male, came in due to a chief complaint of weakness and no verbal output. 2 days prior to consultation, the patient complained of occasional headaches and right-hand numbness however still apparently well at the time. It was elicited from history that the patient was drinking at a party the night prior. No medications were taken nor consultations done. In the interim there is persistence of the occasional headaches and the patient was last seen well on the midnight of the day of consultation. When the patient woke up that morning, he had right-sided body weakness as well as a lack of verbal output which prompted the relatives to immediately bring the patient to the emergency room for consultation.
The patient arrived at the emergency department with stable vital signs and was started on IV Citicoline and capillary blood glucose was monitored and corrected as necessary. Cranial nerve examination revealed poor gag reflex hence a nasogastric tube was inserted. Plain cranial CT scan revealed acute infarcts at the left basal ganglia, left centrum semiovale, and the left temporal lobe as well as a chronic intracranial hemorrhage at the parieto-occipital lobes. The patient was started on mannitol due to the findings of the chronic hemorrhage and was referred to neurology service for co-management.
At the ward, the patient was maintained on mannitol, citicoline, atorvastatin, sertraline, and levetiracetam. Antiplatelets were withheld initially due to the presence of the bleed. After a few days with the patient’s condition stable, the patient was eventually started on swallowing training and was encouraged to speak. The patient was eventually referred to rehab medicine service for physical and occupational therapy prior to discharge. The patient was also started on clopidogrel with clearance from the neurologist. In the end the patient was able to verbalize short phrases and regained most of his strength in his right extremities and the patient was eventually cleared for discharge.
