What abnormalities if any can you see?
Category: Advancing Modules
04: Non contrast CT head
What abnormalities if any can you see?
Case 04
Clinical history and examination
Age: 64 years, Female.
Time of presentation: 19:00
History of event
- Symptoms: husband witnessed stopped speaking, right face, arm and leg weak
- Current time interval since last known well: 1 hr 30 mins (90 mins)
Past medical history
- Diabetes mellitus
- Proliferative retinopathy
- Ischaemic stroke 3 yrs ago
- End stage renal failure
- 3 x weekly haemodialysis (last completed 48 hrs ago)
Relevant medications
- Insulin: not taken today
- Aspirin
Relevant social history
- Living circumstance: at home with husband
- Prior function and care needs: independent in everyday activities
- Work/hobbies: retired shop assistant due to ill health, grandchildren, crosswords
Examination
- Pulse: 82, BP 174/75
- Neuro:
- Handedness: right handed
- NIHSS: 12
- Deficits: mod aphasia, right UMN facial weakness, some effort against gravity in arm and leg but no hand movement
Investigations requested with non imaging results
- BM 23mmol/l
- Hb 80g/dl
- Urea 22mmol/l
- Creat 300umol/l
03: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
03: Update and decisions
Now 4 hrs 25 mins (265 mins) since onset, BP currently 170/74, NIHSS unchanged at 12.
03: CT Angiogram
What abnormalities if any can you see?
03: Non contrast CT head
What abnormalities if any can you see?
Case 03
Clinical history and examination
Age: 64 years, Female.
Time of presentation: 19:00
History of event
- Symptoms: husband witnessed stopped speaking, right face, arm and leg weak
- Current time interval since last known well: 4 hrs 10 mins (250 mins)
Past medical history
- Diabetes mellitus
- Proliferative retinopathy
- Ischaemic stroke 3 yrs ago
- End stage renal failure
- 3 x weekly haemodialysis (last completed 48 hrs ago)
Relevant medications
- Insulin: not taken today
- Aspirin
Relevant social history
- Living circumstance: at home with husband
- Prior function and care needs: independent in everyday activities
- Work/hobbies: retired shop assistant due to ill health, grandchildren, crosswords
Examination
- Pulse: 82, BP 174/75
- Neuro:
- Handedness: right handed
- NIHSS: 12
- Deficits: mod aphasia, right UMN facial weakness, some effort against gravity in arm and leg but no hand movement
Investigations requested with non imaging results
- BM 23mmol/l
- Hb 80g/dl
- Urea 22mmol/l
- Creat 300umol/l
Meet our experienced colleagues
Select the ‘i’ button next to each of our experienced colleagues for more details.
The cases
- You are invited to interpret their history, examination and brain imaging.
- We have provided some representative scan slices which demonstrate the abnormalities.
- Compare your interpretation of the brain scans with that of a neuro radiologist, Dr Paul Armstrong.
- You can make your management decisions.
- Compare your decisions with other experienced stroke clinicians.
