Stroke:Case Study Section 2: Difference between revisions
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'''Vitals:''' | '''Vitals:''' | ||
BP 140/90 mmHg | |||
Pulse 75<br> | |||
'''Physical Exam:''' | '''Physical Exam:''' | ||
''FAST +ve'' | |||
*Left Facial Droop | |||
*Left Motor Weakness: Upper Limb 0/5, Lower Limb 2/5 | |||
*Slurred Speech | |||
''Los Angeles Prehospital Stroke Screen (LAPSS) & Los Angeles Motor Scale (LAMS)'' | |||
{| width=" | {| width="80%" border="1" cellpadding="5" cellspacing="5" align="center" | ||
|- | |- | ||
| '''Criteria''' | | width="60%" | '''Criteria''' | ||
| align="center" width=" | | align="center" width="10%" | '''Yes''' | ||
| align="center" width=" | | align="center" width="10%" | '''No''' | ||
| align="center" width=" | | align="center" width="20%" colspan="2" | '''Unknown''' | ||
|- | |- | ||
| | | | ||
1. Age greater than 45 years | 1. Age greater than 45 years | ||
| Yes | | align="center" | Yes | ||
| | | | ||
| | | colspan="2" | | ||
|- | |- | ||
| | | | ||
Line 77: | Line 80: | ||
| | | | ||
| No | | align="center" | No | ||
| | | colspan="2" | | ||
|- | |- | ||
| | | | ||
3. Onset of Neurological Symptoms is less than 24 hours | 3. Onset of Neurological Symptoms is less than 24 hours | ||
| Yes | | align="center" | Yes | ||
| | | | ||
| | | colspan="2" | | ||
|- | |- | ||
| | | | ||
4. Patient was Ambulatory prior to onset of symptoms | 4. Patient was Ambulatory prior to onset of symptoms | ||
| Yes | | align="center" | Yes | ||
| | | | ||
| | | colspan="2" | | ||
|- | |- | ||
| | | | ||
Line 98: | Line 101: | ||
| | | | ||
| No | | align="center" | No | ||
| | | colspan="2" | | ||
|- | |- | ||
| | | | ||
6. Motor Exam: Examine for Motor Asymmetry | 6. Motor Exam: Examine for Motor Asymmetry | ||
Based on Exam below, patient has | Based on Exam below, patient has <u>'''''Unilateral'''''</u> <u></u>''''Weakness: ''' | ||
| Yes | | align="center" | Yes | ||
| | | | ||
| <br> | | colspan="2" | <br> | ||
|- | |- | ||
| | | | ||
| align="center" | '''Equal''' | | align="center" width="10%" | '''Equal''' | ||
| align="center" | '''Right''' | | align="center" width="10%" | '''Right''' | ||
| align="center" | '''Left''' | | align="center" | '''Left''' | ||
| align="center" width="10%" | '''LAMS SCORE''' | |||
|- | |- | ||
| align="right" | '''Facial Smile / Grimace''' | | align="right" | '''Facial Smile / Grimace''' | ||
| | | | ||
| align="center" | <br> | | align="center" | <br> | ||
| align="center" | Droop | | align="center" | Droop | ||
| align="center" | 1 | |||
|- | |- | ||
| align="right" | '''Grip Strength''' | | align="right" | '''Grip Strength''' | ||
| | | | ||
| align="center" | | | align="center" | | ||
<br> | <br> | ||
| align="center" | | | align="center" width="10%" | | ||
No Grip | No Grip | ||
| align="center" | 2 | |||
|- | |- | ||
| align="right" | ''' Arm Srength''' | | align="right" | ''' Arm Srength''' | ||
| | | | ||
| align="center" | | | align="center" | | ||
<br> | <br> | ||
| align="center" | | | align="center" | | ||
Falls Rapidly | Falls Rapidly | ||
| align="center" | 2 | |||
|- | |||
| align="right" colspan="4" | | |||
| align="center" bgcolor="#ffff00" | 5 | |||
|} | |} | ||
== '''Acute Hospital Assessment''' == | == '''Acute Hospital Assessment''' == |
Revision as of 21:57, 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 Prehospital Stroke Screen (LAPSS) & Los Angeles Motor Scale (LAMS)
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 Unilateral 'Weakness: |
Yes | |||
Equal | Right | Left | LAMS SCORE | |
Facial Smile / Grimace | Droop | 1 | ||
Grip Strength |
|
No Grip |
2 | |
Arm Srength |
|
Falls Rapidly |
2 | |
5 |
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 |