Stroke:Case Study Section 2: Difference between revisions
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'''[https://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf NIH Stroke Scale]: '''16 | '''[https://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf NIH Stroke Scale]: '''16 | ||
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Revision as of 22:11, 2 May 2017
Introduction[edit | edit source]
This case study forms part of the Stroke Course
History of Presenting Condition
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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
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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
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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
Pre Hospital Assessment Scale:
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 145/90 mmHg
- Pulse 82
Physical Exam:
- Confusion
- Left Facial Droop
- Slurred Speech
- Left Motor Weakness Upper Limb 0/5, Lower Limb 2/5
- Decreased Tone
- Altered Sensation
- Mild Left Sided Neglect
Acute Assessment Scale:
NIH Stroke Scale: 16
Level Of Consciousness | 1 |
LOC Questions | 2 |
LOC Commands | 1 |
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 | 2 |
Dysarthria | 2 |
Extinction & Inattention | 1 |
Total Score | 20 |