Відео

شكرا لحضرتك يا دكتور

Missing Points in Diagnosis (Briefly): 1. ABCD² Score: Risk stratification for stroke (moderate-high risk with a score of 5). 2. Brain Imaging: MRI-DWI for silent infarctions; CT/MR angiography for stenosis or plaques. 3. Cardiac Evaluation: Echocardiography and Holter monitoring to rule out cardioembolic causes (e.g., atrial fibrillation). 4. Vascular Imaging: Carotid Doppler to detect stenosis or atherosclerosis. 5. Lipid Profile: Assess cholesterol levels to guide therapy. 6. Hypercoagulability Workup: If cryptogenic TIA suspected (e.g., antiphospholipid syndrome). 7. Secondary Prevention: Start antiplatelet therapy (aspirin/clopidogrel). High-intensity statins (LDL < 70 mg/dL). Blood pressure and glycemic control. 8. Lifestyle Factors: Smoking cessation, weight reduction, and diet optimization. 9. Psychosocial: Evaluate mental health and stress levels. Comprehensive workup and management are crucial to prevent recurrent TIA or stroke.

يا اخي شف لي حل مع الكورس لي ثلاث ايام ما اقدر اذاكر

ربنا يبارك في حضرتك و يديك الصحة

يا جماعة كورس الدكتور متعطل ليه؟ ومتى يتصلح

*We should assess the risk of developing stroke according to the Age, Blood pressure, Clinical features, Duration of the attack, Diabetes. Interpretaion of score : 1-3 = Low / 4-5 = Moderate / 6 or more = high. Unilateral weakness with aphasia = 2 points / Duration of the attack less than 1 hour = 1 points / DM = 1 point / BP = 1 if 140/90 or more "This patient has moderate risk to develope a stroke". *The affected vessel is " the left MCA *Notes about the case : • We should do lipid profile for this patient to assess cholesterol and TGs levels. • A patient with more than 40 yo + DM = Should initiate statin therapy Yahia Smadi

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ما شاء الله تبارك الرحمن

Case 1 A 21 year old normocytic normochromic anemia with pancytopenia with hypercoagulability for dd no 1 Antiphospholipid syndrome 1ry or 2ry to SLE 2 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA pancytopenia with thrombosis 3 MAHA (TTP) microangiopathic hemolytic anemia thrombotic thrombocytopenic purpura Case 2 Severe mictocytic hypochromic anemia in an elderly male with elevated serum iron excluding iron deficiency anemia So could be sideroblastic anemia or lead poisoning Porphyria Confrim diagnosis by bone marrow aspirate and biopsy Case 3 Rest of iron profile BM aspirate and biopsy could be MDS

No1 The prognosis of the case is missing to help predict the likelihood of developing a stroke: *Age less than 60 0 *B Hypertensive so 1 point *Clinically unilateral weakness 2 *Duration LESsthan 60 Min so 1 *Diabetic so 1 With a total score of 5 indicating a moderate risk of developing a stroke. No2 functional diagnosis as regards the complications and associated conditions provided that the patient has metabolic syndrome and atherosclerosis proper assessment and investigations for primary prevention and screening for the macro vascular complications as coronary artery disease, peripheral vascular disease and the microvascular complications in the form of retinopathy, neuropathy, and nephropathy. No3 regarding the anatomical diagnosis it is carotid TIA most probably involving the left main Middle cerebral artery due to the presence of right sided hemiparesis and aphasia No4 etiological already mentioned in the video noncardioembolic carotid TIA due to atherosclerosis (metabolic syndrome) from atheroembolism originating from a carotid artery atheromatous plaque. Last but not least is the Dd of transient hemiparesis : 1. TIAs 2. Todd's paralysis post epileptic 3. Multiple sclerosis 4. Hemiplegic Migraine 5. Hysterical *Alia Mohyi Eldin Amin 01553156685

Missing point in diagnosis: 1) patient is Hypertensive, diabetic, heavy smoker , old age & male gender [3 modifiable & 2 non-modifiable] .. so these factors increase risk of atherosclerosis which is most common cause of TIA (Ulcerated atherosclerotic plaque) in Carotid system. 2) patient risk for developing stroke [ABCD2] => moderate risk [5]: ■ 1 point for hypertension ■ 2 points for unilateral weakness with or without speech disturbance (here there is speech defect) ■ 1 point for duration of attack (10-59 min) ■ 1 point for DM 3) MCA artery is affected in Carotid TIA (due to weakness & Aphasia) So full diagnosis is: Metabolic $ [Abdominal obesity, hypertension & DM] Complicated by TIA in carotid system (MCA) from non-cardioembolic cause (ulcerated atherosclerotic plaque) & prognosis according to ABCD2 to develop stroke is moderate risk. أشرف عصام محمد +201063937315

1) Clinical Diagnosis: Transient Ischemic Attack (TIA) secondary to metabolic syndrome. 2) Anatomical Diagnosis: TIA affecting the left middle cerebral artery (dominant hemisphere). 3) Etiological Diagnosis: Non-cardioembolic TIA due to atherosclerotic disease of the left carotid artery. 4) Diagnosis of the Stage: Acute moderate risk TIA with no permanent deficits (ABCD² score: 5). - Metabolic syndrome (hypertension, diabetes, abdominal obesity) complicated by an acute cortical TIA involving the left MCA cortical branch, affecting the frontal lobe (including Broca's area, area 44) and adjacent motor cortex, presenting as transient right-sided hemiparesis and Broca's aphasia, likely due to atherosclerosis of the left carotid artery. - Risk stratification using the ABCD² score can help predict stroke risk after TIA (As one third of people who had a TIA will develop stroke.): Age (0) + Blood pressure (1) + Clinical features (2) + Duration (1) + DM (1) = 5 moderate risk, need secondary prevention to avoid stroke. - Additionally, given the patient's metabolic syndrome and heavy smoking history, there is a significant risk of systemic atherosclerosis affecting multiple vascular territories. This includes a high risk of coronary artery disease (CAD), as well as potential involvement of the mesenteric arteries, peripheral artery disease (PAD), and renal artery stenosis, all of which should be carefully examined. عمر الصدفي +201050019610

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ربنا يزيدك يارب احسن دكتور فى مصر

Missing Points in Diagnosis (Briefly): 1. ABCD² Score: Risk stratification for stroke (moderate-high risk with a score of 5). 2. Brain Imaging: MRI-DWI for silent infarctions; CT/MR angiography for stenosis or plaques. 3. Cardiac Evaluation: Echocardiography and Holter monitoring to rule out cardioembolic causes (e.g., atrial fibrillation). 4. Vascular Imaging: Carotid Doppler to detect stenosis or atherosclerosis. 5. Lipid Profile: Assess cholesterol levels to guide therapy. 6. Hypercoagulability Workup: If cryptogenic TIA suspected (e.g., antiphospholipid syndrome). 7. Secondary Prevention: Start antiplatelet therapy (aspirin/clopidogrel). High-intensity statins (LDL < 70 mg/dL). Blood pressure and glycemic control. 8. Lifestyle Factors: Smoking cessation, weight reduction, and diet optimization. 9. Psychosocial: Evaluate mental health and stress levels. Comprehensive workup and management are crucial to prevent recurrent TIA or stroke.

I think the differential diagnosis may be the missed : __ thrombotic ( due to polycythemia) . __embolic __ hemorrhagic __. Hysterical

To provide a complete diagnosis for this patient, we need to identify the missing point, which is the etiology or underlying cause of the TIA. Complete Diagnosis: 1. Metabolic Syndrome: Abdominal obesity (BMI 35 kg/m², waist circumference 111 cm) Hypertension Diabetes Mellitus (Type 2) Likely Dyslipidemia (should be confirmed with a lipid profile) 2. Complication: Non-cardioembolic TIA Mild weakness in the right upper and lower limbs Transient aphasia Symptoms resolved within 45 minutes 3. Missing Point: Investigation of Underlying Cause of TIA Atherosclerosis: Common in metabolic syndrome and smoking, leading to stenosis or occlusion of cerebral arteries. Carotid Artery Disease: Check for significant carotid artery stenosis (using carotid Doppler ultrasound). Hypercoagulable State: Investigate if there's a predisposition to thrombosis. Cardiac Source of Embolism: Although this case is labeled as "Non-cardioembolic," atrial fibrillation or other cardiac causes should still be ruled out via ECG and echocardiography. ABCD² score to estimate Risk to stroke in this case . ABCD² Score = 5 points ( moderate Risk to stroke) Next Steps in Management: 1. Perform a carotid Doppler and brain imaging (CT/MRI) to confirm the cause and extent of ischemic changes. 2. Assess the lipid profile to guide statin therapy. 3. Check for HbA1c and optimize diabetes control. 4. Start antiplatelet therapy (e.g., aspirin or clopidogrel) to prevent recurrence. 5. Encourage smoking cessation, weight reduction, and lifestyle modifications. 6. Consider referral to a neurologist or vascular specialist for further evaluations

To provide a complete diagnosis for this patient, we need to identify the missing point, which is the etiology or underlying cause of the TIA. Complete Diagnosis: 1. Metabolic Syndrome: Abdominal obesity (BMI 35 kg/m², waist circumference 111 cm) Hypertension Diabetes Mellitus (Type 2) Likely Dyslipidemia (should be confirmed with a lipid profile) 2. Complication: Non-cardioembolic TIA Mild weakness in the right upper and lower limbs Transient aphasia Symptoms resolved within 45 minutes 3. Missing Point: Investigation of Underlying Cause of TIA Atherosclerosis: Common in metabolic syndrome and smoking, leading to stenosis or occlusion of cerebral arteries. Carotid Artery Disease: Check for significant carotid artery stenosis (using carotid Doppler ultrasound). Hypercoagulable State: Investigate if there's a predisposition to thrombosis. Cardiac Source of Embolism: Although this case is labeled as "Non-cardioembolic," atrial fibrillation or other cardiac causes should still be ruled out via ECG and echocardiography. ABCD² score to estimate Risk to stroke in this case . ABCD² Score = 5 points ( moderate Risk to stroke) Next Steps in Management: 1. Perform a carotid Doppler and brain imaging (CT/MRI) to confirm the cause and extent of ischemic changes. 2. Assess the lipid profile to guide statin therapy. 3. Check for HbA1c and optimize diabetes control. 4. Start antiplatelet therapy (e.g., aspirin or clopidogrel) to prevent recurrence. 5. Encourage smoking cessation, weight reduction, and lifestyle modifications. 6. Consider referral to a neurologist or vascular specialist for further evaluations

To provide a complete diagnosis for this patient, we need to identify the missing point, which is the etiology or underlying cause of the TIA. Complete Diagnosis: 1. Metabolic Syndrome: Abdominal obesity (BMI 35 kg/m², waist circumference 111 cm) Hypertension Diabetes Mellitus (Type 2) Likely Dyslipidemia (should be confirmed with a lipid profile) 2. Complication: Non-cardioembolic TIA Mild weakness in the right upper and lower limbs Transient aphasia Symptoms resolved within 45 minutes 3. Missing Point: Investigation of Underlying Cause of TIA Atherosclerosis: Common in metabolic syndrome and smoking, leading to stenosis or occlusion of cerebral arteries. Carotid Artery Disease: Check for significant carotid artery stenosis (using carotid Doppler ultrasound). Hypercoagulable State: Investigate if there's a predisposition to thrombosis. Cardiac Source of Embolism: Although this case is labeled as "Non-cardioembolic," atrial fibrillation or other cardiac causes should still be ruled out via ECG and echocardiography. ABCD² score to estimate Risk to stroke in this case . ABCD² Score = 5 points ( moderate Risk to stroke) Next Steps in Management: 1. Perform a carotid Doppler and brain imaging (CT/MRI) to confirm the cause and extent of ischemic changes. 2. Assess the lipid profile to guide statin therapy. 3. Check for HbA1c and optimize diabetes control. 4. Start antiplatelet therapy (e.g., aspirin or clopidogrel) to prevent recurrence. 5. Encourage smoking cessation, weight reduction, and lifestyle modifications. 6. Consider referral to a neurologist or vascular specialist for further evaluations

ممكن تعمل حلقة عن headache يا بروف ❤❤

جزاك الله خيرا يا دكتور شريف

تحياتنا لكم برفيسور شريف

Thunderclup headache

To provide a complete diagnosis for this patient, we need to identify the missing point, which is the etiology or underlying cause of the TIA. Complete Diagnosis: 1. Metabolic Syndrome: Abdominal obesity (BMI 35 kg/m², waist circumference 111 cm) Hypertension Diabetes Mellitus (Type 2) Likely Dyslipidemia (should be confirmed with a lipid profile) 2. Complication: Non-cardioembolic TIA Mild weakness in the right upper and lower limbs Transient aphasia Symptoms resolved within 45 minutes 3. Missing Point: Investigation of Underlying Cause of TIA Atherosclerosis: Common in metabolic syndrome and smoking, leading to stenosis or occlusion of cerebral arteries. Carotid Artery Disease: Check for significant carotid artery stenosis (using carotid Doppler ultrasound). Hypercoagulable State: Investigate if there's a predisposition to thrombosis. Cardiac Source of Embolism: Although this case is labeled as "Non-cardioembolic," atrial fibrillation or other cardiac causes should still be ruled out via ECG and echocardiography. ABCD² score to estimate Risk to stroke in this case . ABCD² Score = 5 points ( moderate Risk to stroke) Next Steps in Management: 1. Perform a carotid Doppler and brain imaging (CT/MRI) to confirm the cause and extent of ischemic changes. 2. Assess the lipid profile to guide statin therapy. 3. Check for HbA1c and optimize diabetes control. 4. Start antiplatelet therapy (e.g., aspirin or clopidogrel) to prevent recurrence. 5. Encourage smoking cessation, weight reduction, and lifestyle modifications. 6. Consider referral to a neurologist or vascular specialist for further evaluations

The Missing point in the diagnosis: 1- heavy smoker: increases risk of vascular damage or play significant role in worsening atherosclerosis and vascular damage lead to vascular luminal narrowing 70 % lead to TIA 2- The ABCD² Score to estimate or predict the risk of stroke following TIA : In this cases : 0 (age ) + 1(BP ) + 2 ( clinical features or unilateral weakness) + 0 ( Aphasia) + 1 ( diabetes) + 1 ( duration) = 5 This patient has moderate risk of stroke ( 4 % in 2 days ) Admission to hospital to observation , follow up and Urgent evaluation and management . 3- determined to affected area or blood vascular: inability to speak ( aphasia) results affecting in the Broca's area and the left middle cerebral artery supplies Broca's area in frontal lobe and Wernicke's area in the temporal lobe , both of which are critical for speech production and comprehension. -Cerebral blood vessels spasm •ABCD3-I score. Estimate to risk of stroke •CANADIAN TIA score : Estimate For Risk of stroke For Calculated Risk Score of Stroke or carotid Revascularization in 7 days

And the lesion is probably in the left superiordivision of middle cerebral artery : AS there is rt. hemiparesis (UL+LL) (frontal lobe)+APHASIA(brocas area) +No visual disturbance+ No hemihyposthsia +MCA is the most common affected artery in these cases due to atherosclerotic cerebrovascular disease

Metabolic syndrome complicated by carotid non embolic TIA due to affection of superior branch of middle cerebral artery As there's aphasia , contralateral paresis with NO visual symptoms. moderate risk according to ABCD2 score (5 points A» 0 B » 1 C » 2 D duration » 1 D diabetes » 1 الاسم عمر شريف الرقم مش عارف اكتبه كل شوية اليوتيوب يمسح الكومنت

HUS ??

Missing point: ABCD² score: in this case 5 points ( moderate) . Heavy smoker . Weakness occur while at work. Vascular artery that affected ( left middle cerebral artery) . Lacunar stroke due to hypertension ( most common cause) . Lenticulostriate branches arteries . Atherosclerosis in carotid or it's branches arteries

Prognosis ( According to ABCD2 score) 5 points in this patient This patient is Moderate risk to develop stroke ( Age(0)- BP(1) - Unilateral weakness(2) - Duration(1) - Diabetes(1) ) David Emil Efraim ديفيد اميل افرايم كل ما اكتب رقم التليفون التعليق يتمسح

الحمد لله

من فضلكم هل فيه كورس اونلاين لدكتور شريف الهواري باطنه لطلاب الطب لاني ارغب في التسجيل

لمصرين فقط و لكل الطلبة ؟؟

❤❤❤

The symptoms described in this patient suggest the involvement of the left middle cerebral artery (MCA) territory, which supplies specific regions of the brain responsible for motor function and language. Key Findings Supporting Left MCA Territory Involvement: 1. Right-sided weakness (right upper and lower limbs): The primary motor cortex (precentral gyrus) located in the frontal lobe is affected. The left hemisphere controls the motor function of the right side of the body. The upper limb and face are predominantly represented in the lateral aspect of the motor cortex supplied by the MCA. 2. Inability to speak (aphasia): The Broca's area (in the dominant hemisphere, typically left in right-handed individuals) is involved. The left MCA supplies Broca's area in the frontal lobe and Wernicke's area in the temporal lobe, both of which are critical for speech production and comprehension. In conclusion what was affected in this patient Motor cortex: Causing contralateral (right-sided) weakness. Broca's area: Causing expressive aphasia (inability to speak). This pattern in this patient strongly suggests an ischemic event in the left MCA superior division, which supplies the lateral frontal lobe, including the motor cortex and Broca's area. الاسم محمد أحمد عبدالله محمد رقم التليفون 01090160039

فلسطين قضية الشرفاء يا دكتور شريف

والله ربحت البياع ياغزه العزه والكرامه

A missing point in the diagnosis could be dyslipidemia. Reasoning: Patients with metabolic syndrome, obesity, diabetes, and hypertension, especially those who smoke heavily, often have underlying dyslipidemia, characterized by: Elevated triglycerides Low HDL cholesterol Elevated LDL cholesterol Small, dense LDL particles that are more atherogenic Dyslipidemia is a key contributor to atherosclerosis and increases the risk of ischemic stroke and TIA, particularly in the setting of non-cardioembolic TIA, which is often due to atherosclerosis of the carotid or cerebral arteries. Suggested Additions to the Diagnosis: Dyslipidemia (likely atherogenic dyslipidemia) Atherosclerosis, especially of the carotid arteries These additions complete the picture of vascular risk factors leading to the patient's TIA. Name:- Mohamed Mohamed ali Tel:- +201092100689

بارك الله فيك د. شريف❤

The missing point in the diagnosis may refer to a possible underlying cause or risk factor that has not been explicitly addressed. Possible Missing Points: 1. Dyslipidemia: Often associated with metabolic syndrome, which includes elevated triglycerides and low HDL cholesterol levels. These contribute to atherosclerosis, increasing the risk of TIA. ★ hypertension, diabetes or lipohyalinosis can predispose to microvascular dysfunction or stenosis of the lenticulostriate branches arteries. ( Left middle cerebral artery) 2. Carotid Artery Atherosclerosis: A key factor in carotid TIA. Plaque or stenosis in the carotid arteries could be contributing to the transient ischemia. 3. Lifestyle Factors: Heavy smoking: Increases the risk of arterial damage and thromboembolic events. Smoking, which is already mentioned, plays a significant role in worsening atherosclerosis and vascular damage. 4. Family History: If there is a family history of cardiovascular disease or stroke, it could further support the risk profile. 5. Sleep Apnea: Obesity (BMI 35 kg/m²) and large waist circumference suggest a potential for obstructive sleep apnea, a condition linked to hypertension and increased cardiovascular risk. ( Syncope) ★ lacunar stroke because hypertension and diabetes . Addressing these points through further investigation (e.g., glucose, electrolytes , coagulation profile, lipid profile, and would provide a more comprehensive assessment of the patient's condition Imaging Studies: MRI Brain with DWI (Diffusion-Weighted Imaging): To rule out small infarctions that may indicate a minor stroke. CT Angiography or Carotid Doppler Ultrasound: To detect stenosis, plaque, or arterial dissection in the carotid arteries. ★Prognosis or The ABCD² score is used to estimate the risk of stroke following a Transient Ischemic Attack (TIA). Here's how it is calculated for this patient: Total ABCD² Score : 0 (Age) + 1 (BP) + 2 (Clinical Features) + 1 (Duration) + 1 (Diabetes) = 5 This patient has a moderate risk of stroke (4% in 2 days), and urgent evaluation and management are required. Exclude of Differential Diagnosis: Although TIA is the most likely diagnosis, other conditions should be considered: Hypoglycemia: May mimic stroke-like symptoms because in this cases patient diabetes may be increased taking insulin or antidiabetic drugs or no eating lead to hypoglycemia but usually accompanied by systemic symptoms like sweating, confusion, or loss of consciousness. 2. Focal Seizure with Todd’s Paralysis: Focal weakness after a seizure, but speech difficulty and rapid resolution favor TIA. 3. Migraine with Aura: Can cause transient neurological symptoms, but often associated with headache and sensory disturbances.

1. Functional Diagnosis: TIA is characterized by temporary neurological dysfunction without lasting deficits but with (a MODERATE RISK) score of 5 for developing stroke according to The ABCD2 score as follows: • Age: 0 points. • Blood Pressure: 1 point. • Clinical features: 2 points (unilateral weakness). • Duration: 1 point • Diabetes: 1 point 2. Etiological Diagnosis: The most likely etiology is noncardioembolic atherosclerotic thromboembolism according to the patient’s risk factors: Hypertension, diabetes, and smoking. 3. Anatomical Diagnosis (Site of the lesion ): The left hemisphere of the brain in the middle cerebral artery (MCA) the main artery, not the branches as it affects more than one area away from each other 1-Contralateral hemiplegia 2-Aphasia 4. Pathological Diagnosis: - Transient ischemia caused ATH narrowing of the MCA branch of the carotid system due to plaque formation. Clinical diagnosis is transient Hemiparesis in a metabolic syndrome patient due to TIA in the form of transient hemiparesis (right-sided weakness) and aphasia due to temporary ischemia in the left middle cerebral artery (MCA), likely caused by noncardioembolic atherosclerotic thromboembolism resulting from the patient’s hypertension, diabetes, and smoking. The ischemic event is due to the narrowing of the MCA due to atherosclerotic plaque formation in the carotid system. The patient has a moderate risk of stroke, with an ABCD² score of 5, indicating a need for urgent evaluation and management. عبدالرحمن محمد الرفاعي 01013946192

I think this is lacunar stroke affect deep branch of basal ganglie because pure motor symptoms and mild weakness

دكتور شريف العلم والأخلاق😍❤️❤️❤️

I think the missing part in the diagnosis is the actual cause behind the TIA which is probably carotid artery stenosis or atherosclerosis affecting the carotid artery as the given history shows the patient is male 57 yrs old smoker diabetic hypertensive and experienced TIA attack ( aka symptoms of ischemia ) obese class 2 ( severe obesity) diagnosed metabolic syndrome , which strongly suggest atherosclerosis but for sure we need important further investigation to confirm dx as carotid doppler US which i assume is the first investigation to order in this patient after Brain CT to exclude haemorrhagic stroke also MRA and CTA may be done to evaluate accurately the extent of the atherosclerosis and carotid stenosis and if we suspect a ischemic stroke after exclusions of hge by brain NCCT we can perform a contrast enhanced brain MRI to show the exact level of the stroke if present and sure he will need a full lab ABG lipid profile electrolytes My name is : Ahmed Fahmy Sharaf Phone No. : 01068259735 This comment is written on 22th jan 2025 at 7:25 PM

I think the missing part in the diagnosis is the actual cause behind the TIA which is probably carotid artery stenosis or atherosclerosis affecting the carotid artery as the given history shows the patient is male 57 yrs old smoker diabetic hypertensive and experienced TIA attack ( aka symptoms of ischemia ) obese class 2 ( severe obesity) diagnosed metabolic syndrome , which strongly suggest atherosclerosis but for sure we need important further investigation to confirm dx as carotid doppler US which i assume is the first investigation to order in this patient after Brain CT to exclude haemorrhagic stroke also MRA and CTA may be done to evaluate accurately the extent of the atherosclerosis and carotid stenosis and if we suspect a ischemic stroke after exclusions of hge by brain NCCT we can perform a contrast enhanced brain MRI to show the exact level of the stroke if present and sure he will need a full lab ABG lipid profile electrolytes My name is : Ahmed Fahmy Sharaf Phone No. : 01068259735 This comment is written on 22th jan 2025 at 7:25 PM

انتصرت ايه !!! ... قطاع غزه اتساوا بالأرض ده غير ال ٥٠ الف او يزيد اللي ماتو !!

الدكتور شريف الهواري المحترم اوي ❤

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