What abnormalities if any can you see?
Category: Advancing Modules
16: Non contrast CT head
What abnormalities if any can you see?
Case 16
Clinical history and examination
Age: 32 years, Male.
Time of presentation: 10:00
History of event
- Symptoms: woke at 09.00 unable to speak, right sided weakness
- Current time interval since last known well: went to bed at 02:00 well, now 8 hrs (480 mins) after last seen well
Past medical history
- Heavy smoker
- On methadone programme
- Smokes ‘’white stuff’’
- BMI: 40
Relevant medications
- Methadone
Relevant social history
- Living circumstance: hostel
- Prior function and care needs: normal independent
- Work/hobbies: unemployed
Examination
- Pulse: 120, BP: 200/120
- Neuro:
- Handedness: unknown
- NIHSS: 21
- Deficits: global aphasia, deviated gaze, hemianopia, right sided weakness
Investigations requested with non imaging results
- None
15: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
15: Update and decisions
Now 1 hr 20 mins (80 mins) since onset, BP currently 160/90, NIHSS unchanged at 3.
15: CT Angiogram
What abnormalities if any can you see?
15: Non contrast CT head
What abnormalities if any can you see?
Case 15
Clinical history and examination
Age: 59 years, Female.
Time of presentation: 03:00
History of event
- Symptoms: reduced sensation over left cheek and left hand
- Current time interval since last known well: 1 hr 10 mins (70 mins)
Past medical history
- Hypertension
- Diabetes
- Smoker
Relevant medications
- Bendroflumethiazide
- Ramipril
- Gliclazide
Relevant social history
- Living circumstance: home with husband
- Prior function and care needs: independent
- Work/hobbies: civil servant, hill walking
Examination
- Pulse: 90 reg, BP: 155/90
- Neuro:
- Handedness: right handed
- NIHSS: 3
- Deficits: reduced pin prick sensation on face and hand, slight facial droop, mild drift of left arm but normal hand function
Investigations requested with non imaging results
- BM: 8.5mmol/l
14: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
14: Update and decisions
Now 4 hours 40 mins (280 mins) since diplopia, BP currently 190/100, NIHSS unchanged at 13.
