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Stroke, Ischemic

Even More Weakness

Step 1: View clinicals

A 64 year old man presents with acute onset weakness of the right side of his body and difficulty in speaking, which started 30 minutes earlier. There is no history of fever, headache, or trauma. There was no bladder or bowel incontinence. He was diagnosed with hypertension 10 years ago, which is well controlled on Losartan alone. His medical and drug history is otherwise unremarkable. He does not smoke but drinks socially. A full blood count, serum electrolyte assay, ECG, capillary blood glucose, and coagulation profile are all within normal parameters.

Step 2: Order all relevant investigations

Coronary Angiography

You realize that coronary angiography will waste valuable time.

CT Brain stat

The CT scan reveals increased attenuation of the proximal portion of the left MCA. There is no evidence of hemorrhage.

MRI Brain stat

The MRI scan shows an ischemic infarct in the territory of the left middle cerebral artery.

Lumbar Puncture

The CSF analysis is within normal limits.

Step 3: Select appropriate management

Thrombolysis stat
IV Antihypertensives
Aspirin stat
Nasogastric Tube

Score: ★★☆