Category: Advancing Modules

Case 12

Case 12 CT Angiogram

Clinical history and examination

Age: 84 years, Female.
Time of presentation: 12 noon

History of event

  • Symptoms: fell, fractured right ankle, found to have right sided weakness
  • Current time interval since last known well: 2 hrs 45 mins (165 mins)

Past medical history

  • Osteo arthritis
  • COPD

Relevant medications

  • Inhalers
  • Analgesics

Relevant social history

  • Living circumstance: home alone
  • Prior function and care needs: independent, walks with stick outside
  • Work/hobbies: retired, knitting, volunteer in cafe

Examination

  • Pulse: 70, BP: 166/88
  • Neuro:
    • Handedness: right handed
    • NIHSS: 8
    • Deficits: right facial droop, moderate weakness right arm and leg, no hand function, sensory loss on right

Investigations requested with non imaging results

  • None

11: Update and decisions

Now 3 hrs 20 mins (200 mins) since onset, BP currently 172/85, NIHSS improved from 13 to 9 – now speaking a little and less weak.

Case 11

Case 11 CT Angiogram

Clinical history and examination

Age: 74 years, Male.
Time of presentation: 23:00

History of event

  • Symptoms: witnessed acute onset of right sided weakness, then a few minutes later had tonic clonic seizure which self terminated.
  • Current time interval since last known well: 3 hrs (180 mins)

Past medical history

  • Excess alcohol
  • Previous seizure 5 years ago
  • Cirrhosis with varices (no bleeding)

Relevant medications

  • Thiamine
  • Folic acid
  • Propranolol
  • No anticonvulsants

Relevant social history

  • Living circumstance: home with partner
  • Prior function and care needs: independent
  • Work/hobbies: retired publican, non driver

Examination

  • Pulse: 92 reg, BP: 167/83
  • Neuro:
    • Handedness: right handed
    • NIHSS:  13
    • Deficits: drowsy, weakness of right face, arm and leg, not speaking or following commands

Investigations requested with non imaging results

  • INR 1.4
  • Normal blood count