What abnormalities if any can you see?
Category: Advancing Modules
08: Non contrast CT head
What abnormalities if any can you see?
Case 08
Clinical history and examination
Age: 96 years, Female.
Time of presentation: 09:30
History of event
- Symptoms: Got up from chair, fell hitting head but no LOC, Carers noted left facial droop, left arm and leg weak – patient unware of this.
- Current time interval since last known well: 1 hr 30 mins (90 mins)
Past medical history
- Moderate cognitive impairment
- Large bowel Ca resected aged 86 – no known recurrence
Relevant medications
- None
Relevant social history
- Living circumstance: lives in care home, visited by daughters
- Prior function and care needs: mobile with zimmer, help with washing & dressing
- Work/hobbies: reads, watches TV, participates in activities
Examination
- Frail
- Pulse: 106 irreg, BP 160/90
- Neuro:
- Handedness: left handed
- NIHSS: 13
- Deficits: mild dysarthria, gaze deviation to right, mod weakness of left face, arm and leg, neglect of left
Investigations requested with non imaging results
- ECG AF
- Hb 101g/dl
- MCV 77
07: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
07: Update and decisions
Now 1 hr 30 mins (90 mins) since onset, BP currently 130/90, NIHSS unchanged at 8.
07: CT Angiogram
What abnormalities if any can you see?
07: Non contrast CT head
What abnormalities if any can you see?
Case 07
Clinical history and examination
Age: 52 years, Male.
Time of presentation: 11:15
History of event
- Symptoms: difficulty speaking, left arm and leg weak, unable to stand – no migraine features
- Current time interval since last known well: 1 hr (60 mins)
Past medical history
- Migraine with aura
- Excess use of alcohol
Relevant medications
- None
Relevant social history
- Living circumstance: at home, alone – recently separated
- Prior function and care needs: normally independent, driver
- Work/hobbies: recently made redundant from sales job
Examination
- Pulse: 68 BP: 134/82
- Neuro:
- Handedness: left handed
- NIHSS: 8
- Deficits: face asymmetric, speech non fluent, unable to keep either arm or leg off bed
Investigations requested with non imaging results
- None
06: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
06: Update and decisions
Now 1 hrs 15 mins (75 mins) since onset, BP currently 112/80, NIHSS improved from 14 to 12 – improved power in arm.
