Translated version of 1 Ischemic

stroke.docx


First Moscow State Medical University named after IM
Sechenov
APPROVED

Vice Rector for Academic Affairs,
Professor A.A.Svistunov

Case studies on private neurology
Subject of neurology, neurosurgery
Course IV
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Topic 1: Ischemic stroke

Task 1.
Male 65 years rushed to hospital due to that in the
morning, 2 hours before admission, weakness in the left
extremities. From history we know that the patient is suffering a
long time effort angina, during the last year marked episodes of
high blood pressure to 180/100 mm Hg. Art. During the last
three months were a few short (10 minutes) episodes of transient
blindness in his right eye. On examination: clear consciousness,
blood pressure 180/100 mm Hg. Art., pulse - 80 beats per
minute, regular rhythm, weakened ripple on the right common
carotid artery, but strengthened pulsation of the temporal artery.
In the neurological status: no meningeal symptoms, weakness of
the lower part of the mimic muscles on the left, with protruded
tongue deviates to the left, reducing the strength in his left hand
up to 1 score in the leg up to 4 points, the revival of the left
tendon reflexes, abnormal Babinski sign on the left.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. By and by about b b i and n and m s and e n d s h o p r e x o d
o f th i s l e n t o s n a p r and s r l y and z?
5. W e m e m o f t b s t s a s s a n o and s m e n n e n y o m a t a
and with n o n s h a p t e r and th?
6. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
7. A h e n e?

Task 2.
Woman 70 years old was taken to hospital in connection
with the twins and weakness in the right limbs, which arose
early in the morning on waking. Five years ago, the patient
suffered a myocardial infarction, after which marked bouts of
atrial fibrillation. A month ago, there was an episode of
dizziness and double vision, symptoms completely regressed
within the hour. On examination: clear consciousness, blood
pressure - 180/100 mm Hg. Art., heart rate - 100-140 per
minute, the rhythm wrong. In the neurological status: no
meningeal symptoms, paresis of the facial muscles on the left
esotropia, the movement of the left eyeball outwards minimal
movement in the right limbs missing, they increased tendon
reflexes, Babinski right.
H e a p o l o g and h e i s e and s and n o m p e s?
T o p h e and skil and d and g n o r?
PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
By and by about b b i and n and m s and e n d s on g l o o in o
to p y w e n i and d to o e n i m e to i ts n and r and d?
D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
A h e n e?

Task 3.
Male 55 years hospitalized due to suddenly developed
weakness in the left extremities. From history we know that
during the last 10 years are periodically marked increase in
blood pressure to 180/110 mm Hg. Art. On examination: clear
consciousness, blood pressure - 190/115 mm Hg. Art., pulse - 80
beats per minute, regular rhythm. In the neurological status: no
meningeal symptoms, weakness of the lower facial muscles on
the left, reducing the force in the left extremities to 3 points, the
revival of the left tendon reflexes, Babinski left.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 4.
Woman 60 years old was taken to hospital due to
numbness in the left extremities, arising early in the morning on
waking. For 20 years, suffers from hypertension, normal blood
pressure in the last year - 180-190/100-110 mmHg On
examination: clear consciousness, blood pressure - 200/120 mm
Hg, pulse - 70 beats per minute, regular rhythm. In the
neurological status: no meningeal symptoms, no paresis,
impaired pain and temperature sensitivity on the left side of the
face, trunk and left extremities, reflexes are not changed, no
pathological reflexes. Computed tomography of the head
revealed no changes in the brain.
1. H e a p o l o g and h e skil s and n o m e p and t o p h e and skil
and d and g n o r?
2. By Karlin and h e lis h and d and g n o r?
3. PREFACE p on l and r and s th e m n a t o r e n e s s and W o l
e a n i?
4. D o p o l n and m o m e n s e m e m o d s and with the
corollary of a n i?
5. A h e n e?

Task 5
Male 55 years old was taken to hospital in connection with
the development two hours ago, speech disorders and weakness
in the right extremities. Three years ago, suffered a myocardial
infarction within the last year concerned angina attacks.
Constantly taking one tablet of aspirin (100 mg) in the evening
nitrosorbid several pills a day. On examination: clear
consciousness, blood pressure - 180/100 mm Hg, pulse - 75
beats per minute, regular rhythm. Neurological status:
menigealnyh no symptoms, no spontaneous speech, facing it
understands bad right eye movement is limited, paresis of the
lower part of the mimic muscles of the right, when protruded
tongue deviation to the right, there is no movement in the right
limbs, weakened right all kinds of sensitivity, the recovery of
tendon reflexes Right, right Babinski.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?





Task 6.
Female 65 years rushed to hospital due to weakness in the
left extremities, which arose in the morning and gradually
increases over the next 10 hours. Before disease considered
herself almost healthy. On examination: clear consciousness,
blood pressure - 190/100 mm Hg, pulse - 80 beats per minute,
regular rhythm, systolic murmur in the neck in the projection of
bifurcation of the right common carotid artery. Neurological
status: no meningeal signs, paresis bottom of mimic muscles on
the left, with protruded tongue deviation to the left, weakness in
the left limbs up to 2 points, reduced sensitivity to pain on the
left, the revival of the left tendon reflexes, Babinski left.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r? Example h and a n w and y m Mr. and w ee?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 7.
Woman 70 years old was taken to hospital in connection
with speech disorders that have arisen during the day, 3 hours
ago. For 10 years, suffers from coronary heart disease is a
permanent form of atrial fibrillation. On examination: clear
consciousness, blood pressure - 180/110 mmHg, heart rate - 90-
120 per minute, the rhythm wrong. Neurological status: no
meningeal symptoms, the patient is excited, talkative, it contains
a large amount of verbal paraphasias facing the patient does not
understand it, paresis, sensitivity disorders and other
neurological disorders not.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?


Task 8.
Woman 40 years old was taken to hospital due to
complaints of dizziness, nausea and swallowing violation that
occurred during the day 2 hours ago. At 30 years of age
diagnosed with rheumatic heart disease, about which there is a
cardiologist. On examination: in the mind, in the projection of
mitral diastolic murmur is heard, blood pressure - 150/100 mm
Hg, pulse - 90 beats per minute, regular rhythm, neurological
status: no meningeal signs, ptosis, miosis and enophthalmos
right voice deaf, swallowing impossible, right ear hanging soft
palate and pharyngeal reflex is absent, no paresis of limbs, pain
and temperature sensitivity of the weakened facial right on the
trunk and limbs left intention tremor when the finger-nose and
pyatochnokolennoy samples in the right extremities.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 9.
Male 65 years rushed to hospital due to that 4:00 back
weakness in his right leg. Suffered a stroke a year ago,
accompanied by the development of weakness in the left
extremities, mainly in the leg. Muscle strength is partially
restored. On examination: clear consciousness, blood pressure -
180/100 mmHg, heart rate - 75 per minute, regular rhythm,
systolic murmur in the neck in the projection bifurcation both
common carotid arteries. Neurological status: no meningeal
symptoms, violent crying, positive symptoms of oral
automatism, loss of strength up to 2 points in the right leg and
up to 4 points in the right arm and left leg, the recovery of
tendon reflexes, Babinski on both sides.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?

Task 10.
Female 65 years old was taken to hospital in connection
with advanced two hours ago, weakness in the right extremities.
Six years ago, suffered a heart attack, after which marked
attacks of angina at rest and stress, as well as paroxysmal atrial
fibrillation. On examination: clear consciousness, blood pressure
- 180/100 mmHg, heart rate - 100-140 per minute, the rhythm
wrong. Neurological status: no meningeal symptoms, loss of
visual fields on the left bottom of the paresis of mimic muscles
of the left, with protruded tongue deviation to the left, the lack
of movement in the left extremities with increased muscle tone
and tendon reflexes left Babinski left, lost all kinds of sensitivity
on the left half face, trunk and left extremities.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?

Task 11.
Male 50 years rushed to hospital due to weakness in the
left extremities, which appeared suddenly in the afternoon.
During the last 20 years have seen episodes of high blood
pressure to 180/110 mmHg, normal blood pressure value in the
last year - 160/90 mm Hg On examination: clear consciousness,
blood pressure - 200/120 mm Hg, pulse - 70 beats per minute,
regular rhythm. Neurological status: meningeal signs no loss of
strength in the left extremities to 3 points, the sensitivity is not
changed, the left reflexes were brisk and Babinski detected. On
the third day since paresis disease regressed completely,
computed tomography revealed no changes in the brain.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?

Target 12.
Woman 55 years old was taken to hospital in connection
with complaints of dizziness, nausea, impaired swallowing,
which arose during the day 2 hours ago. For 10 years, marked
by a rise in blood pressure to 180/100 mmHg, about a year
suffer angina pectoris. On examination: consciousness - a clear,
blood pressure - 150/100 mm Hg, pulse - 90 beats per minute,
regular rhythm, systolic murmur is heard in the projection of the
carotid and vertebral arteries on both sides. Neurological status:
no meningeal symptoms, ptosis, miosis and enophthalmos left
deaf voice, swallowing broken left hanging bow of the soft
palate and pharyngeal reflex is absent, no paresis of the limbs,
pain and temperature sensitivity on the face of weakened left on
the trunk and limbs - right and other neurological disorders not.
H e a p o l o g and h e i s e and s and n o m p e s?
T o p h e and skil and d and g n o r?
PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 13.
Male 67 years old hospitalized in connection with
advanced two hours ago weakness in his right leg. During the
last 10 years is suffering from diabetes, hypertension,
paroxysmal atrial fibrillation. Examination revealed a clear
consciousness, blood pressure - 170/100 mm Hg. Art., heart rate
- 92-126 per minute, the rhythm wrong. No meningeal
symptoms, weakness in the proximal parts of the right hand up
to 4 points in his right leg up to 2 points, increased tendon
reflexes on the right, right Babinski, symptoms of oral
automatism.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 14.
A woman 72 years old, suffering from angina of effort,
suddenly developed double objects horizontally, drooping right
century, weakness in the left extremities. An hour later, the
woman was taken to hospital. On examination: a clear
conscience, no signs menigealnyh, ptosis right exotropia, right
eyeball turned outwards and down, right pupil enlarged to light
does not respond. Weakness in the left arm and leg up to 3
points, increased tendon reflexes on the left, the left Babinski.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5) Treatment?

Task 15.
Male 69 years old complained of "reduced vision in his
left eye." This complaint came two days ago. He appealed to the
therapist in the community and was sent to hospital. During the
last 10 years suffers hypertension, angina pectoris. On
examination: blood pressure - 180/110 mm Hg, pulse - 90 beats
per minute, rhythmic. Neurological status: no meningeal
symptoms, loss of left visual field, no paresis, sensitivity
disorders and other neurological disorders not.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?

Task 16.
Female 74 years addressed the clinic in the community due
to the fact that an hour ago, she developed weakness in his left
hand, which is completely gone within 10 minutes. During the
last 20 years suffers hypertension, 15 years - diabetes. On
examination: blood pressure - 160/900 mm Hg, pulse - 90 beats
per minute, regular, systolic murmur in the neck in the
projection of bifurcation of the right common carotid artery, no
neurological disorders.
1. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
2. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
3. A h e n e?

Target 17.
Woman 56 years old was taken to hospital due to
weakness in his right hand and speech impairments. These
disorders have arisen during the day and completely gone within
15 minutes. Doctors "ambulance" was an increase in blood
pressure to 160/100 mm Hg, and the patient was hospitalized
with a preliminary diagnosis of "cerebral hypertensive crisis."
Within 5 years, marked increase in blood pressure to 160/100
mm Hg, normal values of blood pressure - 140/90 mmHg A
week ago, the patient within 10 minutes developed complete
loss of vision in his left eye. On examination: clear
consciousness, blood pressure - 140/100 mm Hg, pulse - 80
beats per minute, regular rhythm, no neurological disorders.
1. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
2. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
3) Treatment?

Target 18.
Male 68 years appealed to the clinic in the community due
to the fact that he has in the past month was four episodes of
short-term (within 5-10 minutes) weakness in the left
extremities. During the last 5 years are marked episodic high
blood pressure to 160/90 mm Hg, normal blood pressure values
- 140/90 mmHg On examination: blood pressure - 160/900 mm
Hg, pulse - 90 beats per minute, regular, systolic murmur in the
neck in the projection of bifurcation of the right common carotid
artery, no neurological disorders.
1. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
2. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
3) Treatment?

Task 19.
A woman 71-year-long suffering hypertension and
diabetes, suddenly develop weakness and clumsiness of the right
extremities, decreased vision to "right eye." During the last 10
years marked episodic high blood pressure to 200/100 mm Hg.
Art., conventional blood pressure values - 150/90 mm Hg. Art.
On examination: clear consciousness, blood pressure - 180/100
mm Hg. Art., pulse - 80 beats per minute, regular, no meningeal
symptoms. Revealed loss of the right visual field, the reduction
of all kinds of sensitivity in the right extremities. With open
eyes patient performs finger-nose and heel-knee sample
satisfactorily, but misses on closing the eyes
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?

Task 20.
Female 38 years addressed in connection with which
developed acute facial asymmetry and weakness in the right
extremities. From history we know that for twenty years she
smokes a pack of cigarettes a day, about ten years have used
oral contraceptives. In children with cleft echocardiography
revealed patent foramen ovale. On examination, consciousness -
a clear, blood pressure - 120/80 mm Hg. Art., pulse - 75 per
minute rhythmic, no meningeal symptoms. In the neurological
status - left eye gap wider right, when closing the left eye is
visible white sclera strip, marked lacrimation, flattened left
nasolabial fold, with a smile face skewed to the right, the power
in the right limbs reduced to 3 points, marked the revival of the
tendon reflexes and symptom Babinski's right.
1. H e a p o l o g and h e i s e and s and n o m p e s?
2. T o p h e and skil and d and g n o r?
3. PREFACE in and p and t e n s o m j k l and n and h e skil and
d and g n o r?
4. D o p o l n and m o m e n s e m e t o b e s o s l e d o a n I?
5. A h e n e?


Head. Univ. Professor V.A.Parfenov

Dean of the medical faculty professor
V.V.Fomin