Stroke:Case Study Section 2: Difference between revisions
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== Introduction == | == Introduction == | ||
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== Pre-Hospital Assessment<br> == | == Pre-Hospital Assessment<br> == | ||
== Acute Hospital Assessment | '''Vitals:''' | ||
*BP 140/90 mmHg | |||
*Pulse 75 | |||
'''Physical Exam:''' | |||
*FAST +ve | |||
**Left Facial Droop | |||
**Left Motor Weakness: Upper Limb 0/5, Lower Limb 2/5 | |||
**Slurred Speech | |||
*Los Angeles Los Angeles Prehospital Stroke Screen (LAPSS) | |||
{| width="100%" border="1" cellpadding="5" cellspacing="5" align="center" | |||
|- | |||
| '''Criteria''' | |||
| align="center" width="15%" | '''Yes''' | |||
| align="center" width="15%" | '''No''' | |||
| align="center" width="15%" | '''Unknown''' | |||
|- | |||
| | |||
1. Age greater than 45 years | |||
| Yes | |||
| | |||
| | |||
|- | |||
| | |||
2. History of Seizures or Epilepsy | |||
| | |||
| No | |||
| | |||
|- | |||
| | |||
3. Onset of Neurological Symptoms is less than 24 hours | |||
| Yes | |||
| | |||
| | |||
|- | |||
| | |||
4. Patient was Ambulatory prior to onset of symptoms | |||
| Yes | |||
| | |||
| | |||
|- | |||
| | |||
5. Blood Glucose between 60 and 400 mg/dl | |||
| | |||
| No | |||
| | |||
|- | |||
| | |||
6. Motor Exam: Examine for Motor Asymmetry | |||
Based on Exam below, patient has only <u>'''''Unilateral'''''</u> <u></u>''''Weakness: ''' | |||
| Yes | |||
| | |||
| <br> | |||
|- | |||
| | |||
| align="center" | '''Equal''' | |||
| align="center" | '''Right''' | |||
| align="center" | '''Left''' | |||
|- | |||
| align="right" | '''Facial Smile / Grimace''' | |||
| | |||
| align="center" | <br> | |||
| align="center" | Droop | |||
|- | |||
| align="right" | '''Grip Strength''' | |||
| | |||
| align="center" | | |||
<br> | |||
| align="center" | | |||
No Grip | |||
|- | |||
| align="right" | ''' Arm Srength''' | |||
| | |||
| align="center" | | |||
<br> | |||
| align="center" | | |||
Falls Rapidly | |||
|} | |||
== '''Acute Hospital Assessment''' == | |||
'''Vitals:''' | |||
*BP 140/90 mmHg | |||
*Pulse Regular | |||
'''Physical Exam:''' | |||
*Slurred Speech and Confusion | |||
*Motor Weakness Left UL 0/5, LL 2/5 | |||
*Decreased Tone | |||
*Altered Sensation | |||
*Altered Proprioception | |||
*Mild Left Sided Neglect<br> | |||
'''[https://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf NIH Stroke Scale]: '''16 | |||
{| width="95%" border="2" cellpadding="2" cellspacing="2" | |||
|- | |||
| Level Of Consciousness | |||
| align="center" | 1 | |||
|- | |||
| LOC Questions | |||
| align="center" | 1 | |||
|- | |||
| LOC Commands | |||
| align="center" | 0 | |||
|- | |||
| Best Gaze | |||
| align="center" | 1 | |||
|- | |||
| Visual Field Testing | |||
| align="center" | 1 | |||
|- | |||
| Facial Palsy | |||
| align="center" | 2 | |||
|- | |||
| Motor Function Arm Right | |||
| align="center" | 0 | |||
|- | |||
| Motor Function Arm Left | |||
| align="center" | 4 | |||
|- | |||
| Motor Function Right Leg | |||
| align="center" | 0 | |||
|- | |||
| Motor Function Left Leg | |||
| align="center" | 2 | |||
|- | |||
| Limb Ataxia | |||
| align="center" | 0 | |||
|- | |||
| Sensory | |||
| align="center" | 1 | |||
|- | |||
| Aphasia | |||
| align="center" | 1 | |||
|- | |||
| Dysarthria | |||
| align="center" | 1 | |||
|- | |||
| Extinction & Inattention | |||
| align="center" | 1 | |||
|- | |||
| align="right" | '''Total Score''' | |||
| align="center" | '''16''' | |||
|- | |||
| | |||
| | |||
|} | |||
== Investigations<br> == | == Investigations<br> == | ||
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== Physiotherapy Objective == | == Physiotherapy Objective == | ||
== Physiotherapy Management == | == Physiotherapy Management == | ||
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Revision as of 21:48, 2 May 2017
Introduction[edit | edit source]
This case study forms part of the Stroke Course
History of Presenting Condition
[edit | edit source]
Michael is a 61 year old Senior Partner in a Law Firm. While eating breakfast Michael experienced sudden onset slurring of speech, had facial droop on his left hand side with weakness in left side upper and lower limbs. Michael's wife Mary spotted these sudden onset of symptoms and immediately called for an ambulance, which arrived within 15 mins.
Past Medical History
[edit | edit source]
Asthma - Dx Aged 8
Hypertension Grade 1 - Dx 5 years ago
Prediabetes - Dx 3 years ago
Medication History[edit | edit source]
Seretide Accuhaler
Ventolin (As Required - Not Required for over 1 Year)
Thiazide
Social History[edit | edit source]
61 Year Old Senior Partner at a Law Firm, recently reduced working hours 20 - 30 hours per week, previously worked 50 - 60 Hours
Planning on retirement in 1 - 2 years
Lives in a Bungalow with his wife Mary, who is a recently Retired Teacher.
2 Adult Children, both married with their own children - 1 lives close by, the other lives overseas.
Lifestyle Changes implmented over past 2 - 3 Years foloowing Dx Prediabetes.
Outside work he enjoys golf, usually playing at least 2-3 per week. Also enjoys playing Bridge with Friends.
Took up walking 3 Years ago following Dx Prediabetes. Walks 5 - 6 days per week for between 30 - 45 mins
Ex-Smoker - Hx Smoking 30 Years x 10 - 15/day - Quit 3 Years ago following Dx Prediabetes
Social Beer Drinker 10 - 15 Standard Drinks per week with 3 - 4 per session, although sometimes after Golf may be more.
Pre-Hospital Assessment
[edit | edit source]
Vitals:
- BP 140/90 mmHg
- Pulse 75
Physical Exam:
- FAST +ve
- Left Facial Droop
- Left Motor Weakness: Upper Limb 0/5, Lower Limb 2/5
- Slurred Speech
- Los Angeles Los Angeles Prehospital Stroke Screen (LAPSS)
Criteria | Yes | No | Unknown |
1. Age greater than 45 years |
Yes | ||
2. History of Seizures or Epilepsy |
No | ||
3. Onset of Neurological Symptoms is less than 24 hours |
Yes | ||
4. Patient was Ambulatory prior to onset of symptoms |
Yes | ||
5. Blood Glucose between 60 and 400 mg/dl |
No | ||
6. Motor Exam: Examine for Motor Asymmetry Based on Exam below, patient has only Unilateral 'Weakness: |
Yes | ||
Equal | Right | Left | |
Facial Smile / Grimace | Droop | ||
Grip Strength |
|
No Grip | |
Arm Srength |
|
Falls Rapidly |
Acute Hospital Assessment[edit | edit source]
Vitals:
- BP 140/90 mmHg
- Pulse Regular
Physical Exam:
- Slurred Speech and Confusion
- Motor Weakness Left UL 0/5, LL 2/5
- Decreased Tone
- Altered Sensation
- Altered Proprioception
- Mild Left Sided Neglect
NIH Stroke Scale: 16
Level Of Consciousness | 1 |
LOC Questions | 1 |
LOC Commands | 0 |
Best Gaze | 1 |
Visual Field Testing | 1 |
Facial Palsy | 2 |
Motor Function Arm Right | 0 |
Motor Function Arm Left | 4 |
Motor Function Right Leg | 0 |
Motor Function Left Leg | 2 |
Limb Ataxia | 0 |
Sensory | 1 |
Aphasia | 1 |
Dysarthria | 1 |
Extinction & Inattention | 1 |
Total Score | 16 |