Stroke Case Studies

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Stroke Case Studies
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Case Study 1

• 72 yo female collapses at home while eating
  dinner with her daughter. EMS brings the patient
  to your ER and you note the following garbled
  speech, right sided hemiplegia, able to briskly
  follow commands with left side, and able to write
  answers to questions. Vitals BP 177/90, P 88 bpm
  and irregular, RR 18, O2 95 on room air

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What is your FIRST action?

1. Administer IV tPa
2. Give 10 mg IV Labetalol
3. Obtain STAT head CT
4. Obtain STAT brain MRI

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Which artery is likely affected?

1. Right Middle Cerebral Artery (MCA)
2. Left Middle Cerebral Artery (MCA)
3. Right Anterior Cerebral Artery (ACA)
4. Left Anterior Cerebral Artery (ACA)

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What is the name of the patients language
disorder?

1. Adams Aphasia
2. Wernickes (receptive) aphasia
3. Brocas (expressive) Aphasia
4. Global Aphasia

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Case Study 2

• Mrs. Liken is a 48 yo female who presents to the
  ED with the worst headache of her life. She
  states the pain is the worst in the back of her
  head and her neck. Past medical hx HTN
  (noncompliant) and tobacco use. Vitals 174/88,
  103, 99 on room air, RR 22

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What is your 1 differential diagnosis?

1. Intracerebral Hemorrhage
2. Subdural Hematoma
3. Epidural Hematoma
4. Subarachnoid Hemorrhage

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Case Study 2
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Given the confirmed diagnosis of SAH, what is
considered the gold standard for diagnosing an
aneurysmal SAH?

1. MRI
2. MRV
3. Angiogram
4. CTA

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While awaiting intervention (coiling or
clipping), what is the number one priority ?

1. Make the patient NPO for the procedure
2. Assure adequate hydration given the large
   contrast load
3. Obtain echocardiogram to assess for myocardial
   stunning
4. Strict blood pressure control to prevent
   re-rupture of the aneurysm

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Case Study 3

• EMS brings a 59 yo homeless male to your
  Emergency Department. No known past medical
  history is known. EMS was called when the patient
  was found in a park on the ground shaking his
  left arm and leg. Positive loss of consciousness
  was briefly noted.

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Case Study 3

• The patient regains consciousness in the
  ambulance but is substantially weaker on his left
  side. He states this is new. EMS initiates CODE
  STROKE per protocol. CT of head is negative for
  hemorrhage and the patient is unable to receive
  an MRI 2/2 bullet fragments.

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Should you consider the patient for IV tPa?

1. Yes
2. No