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Pedagogy and critical appraisal

  Pedagogy topic : Multiple Myeloma  Evidence based Medicine and Critical appraisal of the article : Objective : To investigate whether endovascular thrombectomy alone is noninferior to intravenous alteplase followed by endovascular thrombectomy for achieving functional independence at 90 days among patients with large vessel occlusion stroke . Design : Multicenter, randomized, noninferiority trial conducted at 33 stroke centers in China.  Enrollment took place from May 20, 2018, to May 2, 2020. Patients were enrolled and followed up for 90 days (final follow-up was July 22, 2020). Patients : Patients (n = 234) were 18 years or older with proximal anterior circulation intracranial occlusion strokes within 4.5 hours from symptoms onset and eligible for intravenous thrombolysis. Intervention:  Patients were randomized to the endovascular thrombectomy alone as one arm and other arm as combined intravenous thrombolysis with IV alteplase and endovascular thrombectomy. Comparision: A total
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Cases

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 Case 1  A 30 year old man who is an electrician by occupation came with complaints of         Sudden onset weakness of right upper limb and right lower limb 2 days back       Deviation of mouth to left side since 2 days History of present illness:    Patient was apparantly asymptomatic 2 days back then he developed weakness of right upper limb and right lower limb which was sudden in onset associated with deviation of mouth to left side and slurring of speech. Weakness was predominantly on right arm than righ leg. There was no diurnal variation of weakness and   No history of  wasting or thining of muscles No history of  pain or muscle cramps or fasiculations and any involuntary movements No history of tingling , numbness or any pricking like sensation. No history of loss of consciousness or alteration in sensorium or any bowel bladder involvement. And speech aphasic. No history of alteration of smell, blurring of vision, diplopia, dysphagia. Frowning and ability to close eyelids pres
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