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With 2 children
Roman Catholic
27, 2006
RIGHT ARM AND LEG
NUMBNESS
Patient was of GOOD FUNCTIONAL
CAPACITY
of NUMBNESS
Developed WEAKNESS
on his RIGHT HAND and
LEG
He was immediately
brought to E.R.
Ambulatory with difficulty
1st BP = 180/100
Cholesterol = Elevated
Triglyceride = Elevated
RBS = Elevated
CBC = Normal
BUN-CREA = Normal
CT = Unremarkable
WEAKNESS
(+) Headache (-) Weight Loss
(-) Blurring of Vision (-) loss of
(-) Loss of Balance
Appetite
(-) Incontinence
(-) Fever
(-) Difficulty in
(-) Bowel
Swallowing
Disturbances
(-) Heart Disease
(-) Previous Surgeries
Beverages Drinker
Prefers to eat MEAT and
SALTY FOOD
Awake
Stretcher-Borne
BP = 160/100
HR = 80-90(Irregular)
RR = 30
T = afebrile
Pink Conjunctivae, Anicteric Sclerae
No Cervical Lymphadenopathies
No Crackles
Distinct Heart sounds, irregular rate and
rhythm, No Murmurs
Abdomen flat, Soft, Non-tender, No Palpable
Masses
Pink Nailbeds, full pulses, No Edema
Awake
UNCOOPERATIVE
NO VERBAL OUTPUT
UNABLE to FOLLOW
COMMAND
CN II - Distinct Disc Borders
- NO Hemorrhages on Fundoscopy
CN III - Pupils 3mm equal
- Briskly Reactive to Light
CN III, IV and VI – Preferential Gaze to
the LEFT
- NO Response to Visual threat on the
RIGHT
CN V and VII – Sluggish Corneal on the
RIGHT
CN VII - Shallow Right Nasolabial Fold
EXTREMITIES
SENSORY:
NO RESPONSE on the RIGHT on
PAINFUL STIMULATION
+++ ++
+++ ++
+++ ++
+++ ++
(+) Babinski, R
Cerebellars : No Nystagmus
Admitted to hospital on
NUMBNESS
In GOOD FUNCTIONAL CAPACITY
Relatives
(+) Diabetes - Maternal Relatives
Smoker – 1 pack/day x 50 years
Heavy Alcoholic Beverages Drinker
90(Irregular)
RR = 30
STIMULATION
CN III, IV & VI - Preferential Gaze to LEFT
- NO Response to Visual threat on the
RIGHT
CN V and VII – Sluggish Corneal on the
RIGHT
CN XII – Tongue deviated to the RIGHT
(+) Babinski, R
Cerebellars : No Nystagmus
paralysis muscles
(-) Muscle Muscular
atrophy fasciculation
Spasticity Muscular
In hemorrhagic stroke, bleeding in the brain itself
(intracerebral hemorrhage) or between the brain and the
skull (subarachnoid hemorrhage) disrupts brain function
Bleeding usually occurs because of a rupture in arterial walls
that are already weakened by high blood pressure.
A pool of blood compresses brain tissue in its vicinity,
preventing adequate amounts of fresh blood from reaching
the area.
RULED IN: RULED OUT:
Severe headache Nausea
Chronic high blood
Vomiting
pressure Seizures
Weakness, loss of
Vision may
sensation, and
numbness, be impaired
Unable to speak or or lost
become confused
RULED IN: RULED OUT:
Amaurosis fugax - or transient
Neurologic Signs monocular blindness, occurs
and Symptoms from emboli to the central
retinal artery of one eye
(Motor and Disappears within 24 hours
Sensory Deficits)
RULED IN:
Occurred at rest
Diabetes, Hypertension, Smoking
Absence of pain
Weakness
Evidence of Peripheral
Embolism (?)
Arrhythmia (PE
Chest pain (heavy, squeezing,
crushing)
Syncope
Presence of a murmur
Severe headache with exertion
Sudden onset headache
Aphasia
massive headache
Massive headache then Loss of
Consciousness
With neck stiffness
aneurysm easily)
Watershed Infarcts present (Visible in
CT)
RULED IN: RULED OUT:
(-) Trauma --- ?
Hemaparesi S/Sx gradually develops
Altered Consciousness
No Nuchal Rigidity
Seizures
Fever
With Nuchal
Rigidity
Causes include myocardial infarction, cardiac arrest,
shock, asphyxiation, paralysis of respiration, and
carbon monoxide or cyanide poisoning. In some
circumstances, hypoxia may predominate. Carbon
monoxide and cyanide poisoning are termed
histotoxic hypoxia since they cause a direct
impairment of the respiratory chain.
Tachycardia
Tachypnea
Proximal Weakness
Proximal Paralysis
Loss of Consciousness within Seconds
Memory Deficit
Hemiplegic Migraine)
Hemiparetic
No Scotoma
No Slowly Developing
Hemiplegic Hemianopia
Absence of History of Migraine
Aphasic
RULED IN: RULED OUT:
(+) Evolution of
headache symptoms is
Paresis
GRADUAL
Hemianest
CT scan was
unremarkable
hesia 5 days PTA
A vascular event secondary to real diseases of blood
vessel of the brain
Occurs when the blood supply to a part of the brain is
blurry
Confusion or trouble understanding
Trouble walking
Headache
Aphasia
- inability to speak or
understand language from
involvement of Broca’s or
Wernicke’s area
Apraxia
- altered voluntary
movements
Visual field defect
Memory deficits
-involvement of TEMPORAL LOBE
Hemineglect
Anosognosia
High Cholesterol/Triglycerides
Cigarette Smoking
Atrial Fibrillation
The most common type of stroke
It is a sudden loss of function due to loss of
of electrical
activity in the
heart
Take a picture of your
heart and the circulating
blood.
Ultrasound probe may
be placed on your chest
(trans-thoracic
echocardiogram, TTE) or
Routine test to
determine the
number of red blood
cells, white blood
cells, and platelets in
the blood
PT (Prothrombin time)
PTT (Partial
thromboplastin time)
INR (International
normalized ratio
Measure how quickly
Most important test in emergency stroke
evaluation is glucose because levels of
blood glucose which are too high or too
low can cause symptoms which may be
mistaken for stroke
Diagnosis of diabetes, which is a risk
compressible site
Systolic above 185mmHg or