Stroke

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍minhour history of ‍symptoms suggestive of stroke

Symptoms include:

‍face drooping

‍arm weakness

‍leg weakness

‍speech difficulty

‍confusion

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍loss of vision

‍dizziness

‍loss of consciousness

‍loss of balance

‍trouble walking



Contributing factors:

‍smoking

‍obesity

no history of: ‍stroke or TIA episodes, ‍atrial fibrillation, ‍diabetes mellitus, ‍hypertension, ‍hyperlipidemia, ‍coronary artery disease

no use of: ‍aspirin, ‍clopidogrel, ‍anticoagulants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk





ASSESSMENT:

‍Cerebrovascular accident ‍likelysuspectedpossible

DDx: ischemic stroke, hemorrhagic stroke, transient ischemic attack, migraine with aura, seizure, brain tumor, subdural hematoma, encephalitis, meningitis, multiple sclerosis, global transient amnesia, hypoglycemia, metabolic encephalopathy, syncope, benign positional vertigo, vestibular neuronitis, labyrinthitis, drug intoxication, posterior circulation ischemia, arterial dissection, vasculitis, hypertensive encephalopathy





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍lipid profile, ‍INR/PTT, ‍CRP

- ECG

- CT scan of the head

- MRI of the head

- Carotid ultrasound

- Echocardiogram

Treatments:

- ‍Antiplatelets

- ‍Anticoagulants

- ‍Statins

- ‍Antihypertensives

- ‍Thrombolytics

- Physiotherapy

- Speech therapy

- Occupational therapy

Further care:

- Referral to neurologist

- Referral to physiatrist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as severe headache, sudden vision changes, or sudden weakness or numbness