What abnormalities if any can you see?
Category: Advancing Modules
18: Non contrast CT head
What abnormalities if any can you see?
Case 18
Clinical history and examination
Age: 76 years, Female.
Time of presentation: 15.30
History of event
- Symptoms: slurred speech, severe left sided weakness of which the patient seemed unaware
- Current time interval since last known well: 1 hr (60 mins)
Past medical history
- Smoker
- Lung cancer with hilar lymph node involvement
- Liver mets
- Receiving palliative radiotherapy
Relevant medications
- Prednisilone
Relevant social history
- Living circumstance: home with husband and daughter
- Prior function and care needs: independent
- Work/hobbies: retired nurse, puzzles
Examination
- Pulse: 72 reg, BP: 140/80
- Neuro:
- Handedness: right handed
- NIHSS: 15
- Deficits: dysarthria, severe left face, arm and leg weakness and neglect with field defect
Investigations requested with non imaging results
- None
17: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
17: Update and decisions
Now 5hrs 20 mins (320 mins) since entirely normal, BP currently 180/90, NIHSS still 1 at the moment.
17: CT Angiogram
What abnormalities if any can you see?
17: Non contrast CT head
What abnormalities if any can you see?
Case 17
Clinical history and examination
Age: 69 years, Female.
Time of presentation: 18:00
History of event
- Symptoms: fluctuating aphasia and right sided weakness
- Current time interval since last known well: symptoms have been fluctuating, at best just hesitancy of speech but at worst severe aphasia and unable to keep arm and leg off bed during NIHSS. Last was normal 5 hrs (300 mins) ago, but for last hour has only mild aphasia.
Past medical history
- Previous MI
- Hypertension
Relevant medications
- Aspirin
- Amlodipine
- statin
Relevant social history
- Living circumstance: home alone
- Prior function and care needs: normally independent
- Work/hobbies: retired teacher, reading
Examination
- Pulse: 77, BP: 190/86
- Neuro:
- Handedness: right handed
- NIHSS: 1 (currently) , but 11 then 14 when at worst
- Deficits: currently mild aphasia, reduced fine finger movement in right hand
Investigations requested with non imaging results
- None
16: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
16: Update and decisions
Now 8hrs 20 mins (500 mins) since last seen well, BP currently 190/110, NIHSS unchanged at 21.
