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My Pt's age is 42 years paralytic since 4 years MRI large acute infarct involving perisylvian right frontotemporal lobe, basal ganglia and periventricular region (MCA territory) old send me information Pt's chief complain is severe convulsions in the morning. No drugs continue. Physio is continue to prevent contracture.
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Dear, If the patient is having a large old infarct and presently having convulsion it is most likely secondary to the gliosis in the brain. There may be other reasons like another Stroke (as patient not on regular medication) other triggering factors like dyselectrolytaemia, infection etc. I think you should recommend urgent admission as he will require urgent management of the seizure, investigations for the reasons mentioned and other supportive care including management of complications, optimization of treatment of Stroke (or new event if any). Regards.
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