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Case
Study: Stroke
INITIAL HISTORY:
Ø
76
year old man, slightly confused
Ø
Wife
describes symptoms starting 30 minutes ago
Ø
Sudden
onset of difficulty getting his mouth to form words; speech is slurred
Ø
Face
and mouth numb; tongue feels ‘thick’
Ø
Unable
to hold his coffee cup in his right hand
Ø
Right
leg weak; needs to hold on to the table to stand
Question 1: What is your differential diagnosis based
on the information you have now?
Question 2:
What other
questions would you like to ask?
ADDITIONAL HISTORY:
Ø
History
of essential hypertension
Ø
Has
not been taking his thiazide diuretic because it makes him feel ‘bad’
Ø
Was
told he has high cholesterol but has not returned to see his primary care
provider
Ø
Has
experienced several brief spells of right-sided weakness which resolved in a
few minutes; thought this was his arm falling asleep
Ø
No
head trauma or recent infections
Ø
Family
history; mother died of stroke, father died of acute myocardial infarction
(AMI)
Ø
Smokes
1 pack/day of cigarettes for the past 30 years
Ø
Sedentary
lifestyle
Question 3:
Now what do you
think?
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