What abnormalities if any can you see?
Category: Advancing Modules
10: Non contrast CT head
What abnormalities if any can you see?
Case 10
Clinical history and examination
Age: 78 years, Female.
Time of presentation: 13.45
History of event
- Symptoms: weakness of left face, arm and leg only
- Current time interval since last known well: 2 hrs 10 mins (130 mins)
Past medical history
- ICH
- Previous ICH 4 yrs ago with good recover
- MRI some microbleeds
Relevant medications
- No antithrombotics
- Amlodipine
- Bendroflumethiazide
Relevant social history
- Living circumstance: at home, alone
- Prior function and care needs: independent
- Work/hobbies: retired GP, looking after grand children, travel, driver
Examination
- Pulse: 80 reg, BP: 173/94
- Neuro:
- Handedness: right handed
- NIHSS: 8
- Deficits: left hemiparesis only
Investigations requested with non imaging results
- None
09: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
09: Update and decisions
Now 4hrs 15 mins (255 mins) since onset, BP currently 172/85, NIHSS unchanged at 6.
09: CT Angiogram
What abnormalities if any can you see?
09: Non contrast CT head
What abnormalities if any can you see?
Case 09
Clinical history and examination
Age: 63 years, Male.
Time of presentation: 19:00
History of event
- Symptoms: Loss of vision to left, mild weakness in left arm and leg
- Current time interval since last known well: 4 hrs (240 mins)
Past medical history
- Prosthetic mitral valve
- AF
- had GI bleed 5 years ago when INR >5
- No recent GI symptoms
Relevant medications
- Warfarin
- Bisoprolol
- Furosemide
Relevant social history
- Living circumstance: at home with partner
- Prior function and care needs: independent and active
- Work/hobbies: company director, driver, keen golfer
Examination
- Pulse: 66 irreg, BP: 155/80
- Neuro:
- Handedness: right handed
- NIHSS: 6
- Deficits: left hemianopia, drift left arm and leg, mild sensory loss on left, sensory inattention
Investigations requested with non imaging results
- ECG: AF
- FBC normal
- INR 1.7
08: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
08: Update and decisions
Now 1 hr 45 mins (105 mins) since onset, BP currently 142/83, NIHSS unchanged at 13.
