OSCE AND LEARNING POINTS. 5/12/23 prefinals

OSCE AND LEARNING POINTS OF A CASE OF CEREBRO VASCULAR ACCIDENT.
5/12/23

OSCE:
1.𝐖𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐬𝐞𝐧𝐬𝐨𝐫𝐲 𝐚𝐧𝐝 𝐦𝐨𝐭𝐨𝐫 𝐚𝐫𝐞𝐚𝐬 𝐬𝐮𝐩𝐥𝐥𝐢𝐞𝐝 𝐛𝐲 𝐌𝐂𝐀 𝐚𝐧𝐝 𝐰𝐡𝐢𝐜𝐡 𝐚𝐫𝐞 𝐚𝐟𝐟𝐞𝐜𝐭𝐞𝐝 𝐢𝐧 𝐭𝐡𝐢𝐬 𝐜𝐨𝐧𝐝𝐢𝐭𝐢𝐨𝐧? 
• The middle cerebral artery (MCA) primarily supplies blood to various regions of the cerebral cortex. Sensory and motor areas supplied by the MCA include parts of the face, upper and lower limbs, and areas involved in sensory and motor functions. The specific regions can vary among individuals, but generally, the MCA contributes to the blood supply of the lateral convexity of the cerebral hemisphere. This includes the precentral gyrus (primary motor cortex) and the postcentral gyrus (primary somatosensory cortex). Damage to the MCA can lead to motor and sensory deficits on the contralateral side of the body.


2. CLINICALLY WHERE DO YOU LOCALIZE LOSS OF SPEECH IN A PATIENT?

Ans: In clinical terms, the localization of speech loss in a patient is often associated with different areas of the brain. Broca's area, located in the left frontal lobe, is typically associated with motor aspects of speech production. Damage to Broca's area can result in non-fluent or expressive aphasia, where the patient may have difficulty forming grammatically correct sentences and expressing themselves verbally.

On the other hand, Wernicke's area, situated in the left temporal lobe, is associated with language comprehension. Damage to Wernicke's area can lead to fluent or receptive aphasia, where the patient may produce speech that lacks meaning, and they may have difficulty understanding language.

3.𝐖𝐡𝐲 𝐛𝐫𝐨𝐜𝐚𝐬 𝐚𝐫𝐞𝐬 𝐢𝐬 𝐚𝐟𝐟𝐞𝐜𝐭𝐞𝐝 ?

• Broca's area is located in the frontal lobe of the brain, specifically in the left hemisphere. It's situated in the posterior part of the frontal gyrus, which is responsible for speech production and language processing. It is supplied by the middle cerebral artery. So in MCA infarct it can affect this brocas area and can lead to difficulty in speech.


4.What is the role of aspirin and clopidogrel in CEREBRO VASCULAR ACCIDENT 

   *Aspirin and clopidogrel are antiplatelet medications commonly used in the management of cerebrovascular accidents (CVAs), also known as strokes. They help prevent blood clot formation by inhibiting platelet aggregation, which is crucial in reducing the risk of further vascular events.

"Aspirin" works by blocking the action of an enzyme called cyclooxygenase, thereby inhibiting the production of thromboxane A2, a substance that promotes platelet aggregation. Clopidogrel, on the other hand, is a platelet inhibitor that blocks the activation of platelets by preventing specific receptors from binding.

5. Role of dual antiplatelet therapy in CEREBRO VASCULAR ACCIDENT ?

 *Dual antiplatelet therapy (DAPT) involves the use of two antiplatelet medications concurrently, commonly aspirin and clopidogrel, to further reduce the risk of recurrent cerebrovascular accidents (CVAs). The rationale behind DAPT is to enhance the antiplatelet effect and inhibit different pathways involved in platelet activation and aggregation.

The combination of aspirin and clopidogrel is often prescribed after certain types of ischemic strokes or transient ischemic attacks (TIAs). This approach is particularly relevant in cases of acute coronary syndrome or high-risk conditions, where the benefit of preventing blood clot formation outweighs the potential risks associated with dual therapy.

* The duration of dual antiplatelet therapy is also carefully determined based on the specific circumstances of each patient.


6.Role of statins in CVA?

  *Statins play a significant role in the management of cerebrovascular accidents (CVAs), particularly ischemic strokes. Ischemic strokes are often caused by atherosclerosis, a condition characterized by the buildup of cholesterol and fatty deposits in the arteries supplying blood to the brain. Statins are a class of medications that primarily target cholesterol levels in the blood.


LEARNING POINTS:

* This was a very informative session.
* I have learnt about broca's and wernicke's areas affecting speech.
* This helped me to improve my skills and knowledge.
* Learnt about various treatment options and their mechanism of action.
* I got to know about various causes of brain infarcts .
* I also learnt about detailed history taking and examinations of systems

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