Like I mentioned before,in medicine ,nothing is impossible.As long as you can reason out how it happens,then everyone will "Aaaaaa..","Ooooo..." eventhough it was INVALID for them before!
It was what happened to me today!
I kept argued with my colleague about the diagnosis in PBL trigger this morning.
"It's hemorrhagic stroke,right?"I was kindly asking.
"But I think this patient suffered from ishemic stroke.85% of stroke patients are having ischemic stroke rather than hemorrhagic stroke which contributed only 15%."
Nodded,yup agree!No doubt.Then,I gave her my points.
"The patient has been diagnosed with hypertension several years ago and not compliance with the anti-hypertensive drugs.So,this might be the risk factor for having stroke."
"But,hypertension can also lead to ischemic stroke by forming the atherosclerosis."
"Ya.But most of them will develop hemorrhagic stroke.How?The vessels can't stand the high blood pressure,then it will burst.Second is that,other that hemiplagia and slurred speech(which is the common presentation for both type of strokes),the patient also suffered from headache and vomiting.Normally,when headache and vomiting come together,it is most likely due to increase in intracranial pressure.So,here we can say that when the vessel burst,it will cause hemorrhage whether in cerebral,subarachnoid or ventricular system.Then,intracranial pressure increase,leads to headache and also vomiting."
"Ishemic stroke also can cause headache,right?"
"Yup,but not with vomiting.Headache in ischemic stroke is more due to reduced in blood supply to the brain secondary to occlusion of the blood vessels by atherosclerosis."
Then,when Dr came in and started giving the second trigger,we smiled looking at what was stated there.CT scan : Hemorrhage in the left internal capsule.......
There you are!
Invalid to you but valid to me!
Live as if you were to die tomorrow
Learn as if you were to live forever