Before/After Image

A case study of severe Ischemic stroke

Details of the Patient

  • Patient's Name: Shankuntala Batula
  • Patient's Age: 66
  • Patient's Gender: female

Symptoms shown by the Patient

  • Clenching of Teeth
  • 1 episode of vomiting.
  • Left-sided weakness for 2 hours.
  • Deviation of mouth to the right side for 2 hours.

An Overview of the Case

By Dr Ramit Singh Sambyal.

Mrs Shakuntala visited Dr Ramit, who is considered the best general physician in Vasant Kunj by his patients.

 

The patient came to us on a stretcher with clenching of teeth and a history of vomiting. She was accompanied by 1 attendant who gave a history of left-sided weakness associated with deviation of mouth to the right side. Mrs Shakuntala was immediately given a loading dose of injection levetiracetam 1500mg iv in 100ml inj pantocid 40mg iv and inj emeset 8mg iv. 

 

After initial stabilization and assessment, she was immediately taken up for NCCT of the head, which was inconclusive. After getting in touch with a neurologist and a thorough, detailed secondary examination, Mrs Shakuntala was then taken up for MRI of the brain scan, which showed Ischemic Stroke. 

 

Mrs Shakuntala was in thrombolysis as she was still in window period using inj Actilyse( 6mg bolus f/b 54mg infusion dose) was given in an emergency. This was followed by CT angio neck and brain, which showed incomplete clot lysis, and then the patient was taken up for mechanical thrombectomy and was successfully performed. Mrs. Shakuntala presented a seizure-like symptom to emergency with proper and detailed history examination, and investigations turned out to be an Ischemic Stroke. 

 

Brain Scan of Mrs Shakuntala

Treatment Provided to the Patient

Medical Tests Performed

  • Noncontrast CT (NCCT) of the head
  • Electrocardiogram (ECG).
  • Magnetic resonance imaging (MRI) of the brain.
  • Random blood sugar (RBS).
  • Complete Blood Count (CBC).
  • Kidney function test (KFT).
  • Urine Routine and Microscopy (R/M).
  • Cardiac enzymes (TROP I - Negative).
  • CT ANGIO neck and brain.
  • Liver function tests (LFT).

Feedback from the Patient

This is what our patient had to say regarding her treatment from Dr Ramit Singh Sambyal : " Feel awesome after the treatment."

Relevant Case Studies

Generalized Anxiety Disorder Treatment

The patient was suffering from anxiety and palpitation for two months. At the first consultation, the patient explained his problem to the doctor. 

Dr Ramit being the general physician in Safdarjung, New Delhi, examined and assessed her clinically. He inquired about her detailed medical history. As the complication was psychological, the doctor had to get a clear image of her life incidents, whether she had faced any shock or any accident previously in her life. 

 

After knowing the detailed history and examination results, Dr Ramit, the best general physician doctor in Safdarjung, diagnosed the complication to be Generalised Anxiety Disorder.

 

So, he prescribed selective serotonin reuptake inhibitors (SSRI) and anti-anxiety medications for one month. The patient was advised for lifestyle modification which included -

  • Daily walk for at least 20 to 30 mins 5 times a week 
  • Deep breathing with meditation, yoga 
  • Rhythmic exercise and other activities 
  • A healthy diet and proper sleep

Most effectively, the counselling sessions positively worked for her.

 

Treatment:

  • Anti-anxiety medication
  • Lifestyle changes
  • psychological counselling

COVID-19 Patient Treated with Conservative Management

Mrs Laxmi, 48, visited Dr Ramit one of the best general physician in Safdarjung, New Delhi. The patient had a history of high-grade fever for 4 days associated with cough throughout the day. 

 

The patient was initially put on antibiotics and antiviral treatment for 5 days and RT-PCR test was done which came out to be negative. Thinking on lines of covid patient was given fabiflu and antibiotics escalated as she had a high TLC count. 

 

HRCT of the chest was done ( CTSS of 10). Mrs Laxmi had an oxygen saturation of 90 Percent at RA. She was put on oral and inhalational steroid therapy and dosage was adjusted accordingly. Home oxygenation was advised.

 

The patient responded well to the treatment and after 17 days of management RT PCR was done which was negative and HRCT of the chest showed no signs of infection.

 

Case Study Images
Case Study Images

A Case study of Myelodysplastic Syndrome and Lymphoma

Mr. Sharma, a 71-year-old patient, visited Dr. Ramit, who is considered the best general physician in Vasant Kunj, Delhi. The patient came to the emergency department with a history of weight loss for 2-4 months. 

 

Dr. Ramit found that the patient had a generalized weakness, anorexia, abdominal discomfort, and a lump on the abdomen's left side for 2 months. Upon examination, Dr. Ramit also found that Mr. Sharma had few lymph nodes in the occipital region on examination. 

 

The patient had no fever, cough, SOB, chest pain, burning in urine. No past medical or surgical history. Non-smoker and non-alcoholic. No record of recent travel. Upon further investigation, the doctor analysed that the:

  • USG WA( 3/4/21) - Spleen measured 16.7 cm
  • USG WA( 9/4/21)- Spleen measured 18.4 cm
  • TLC - 20,100
  • Platelet count- 56,000
  • Hb- 10.8, neutrophil- 24, lymphocytes- 70, eosinophils- 6
  • MP slide- Negative
  • Typhidot- Negative


Mr. Sharma was admitted for the following investigations: CBC, LFT, KFT, Urine culture and routine, CECT whole abdomen, CECT whole abdomen chest and neck, peripheral blood smear, FNAC Occipital lymph node, BCR-ABL, FISH, 2D ECHO, ECG, chest Xray. 

 

After the test, Dr Ramit concluded that the patient was suffering from myelodysplastic syndrome and lymphoma. So, the doctor treated him with symptomatic management.

 

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