Case study A 78-year-old 84.1 kg white man presents to the emergency department with weakness in his left arm and leg and difficulty speaking. His symptoms began approximately 2 hours ago, prompting his wife to call the paramedics. His past medical history is significant for hypertension, dyslipidemia, and a previous stroke 2 years ago. He experienced a transient ischemic attack 1 week ago, but did not seek medical care. Social history is significant for moderate alcohol use and cigarette smoking half pack per day for the past 50 years. Current medications include perindopril 4 mg once daily, simvastatin 40 mg daily, aspirin 81 mg daily, and a multivitamin tablet once daily. What signs and symptoms does the patient have that are suggestive of stroke? What non-modifiable and modifiable risk factors does he have for acute ischemic stroke? Is he eligible to thrombolysis treatment?
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Signs and symptoms suggestive of a stroke: The patient's symptoms of weakness in his left arm and leg and difficulty speaking are classic signs of a stroke. These symptoms are often summarized by the acronym FAST: Face drooping, Arm weakness, Speech difficulty, Show more…
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A 72-year-old man presents to the emergency department with acute onset of right sided weakness. The patient was eating breakfast when he suddenly lost strength on the right side of his body such that he was unable to move his right arm or leg. He also noted a loss of sensation in the right arm and leg and difficulty speaking. His wife called 911, and he was brought to the emergency department. His medical history is remarkable for long standing hypertension, hypercholesrolemia, and recently diagnosed coronary artery disease. On physical examination, his blood pressure is 190/100. Neurologic examination is notable for right facial droop and a dense right hemiparesis. Ct scan of the brain shows no evidence of hemorrhage. The patient is admitted to the neurologic ICU. What underlying disorder may be responsible? How does it result in stroke?
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