An 84 year old male with a history of high blood pressure and heart disease has a sudden onset of paralysis and numbness on the left side of his face, left arm and leg. He is having difficulty walking and his speech is slurred. After an examination was completed, it is noted that his left side of his mouth is drooping and when he raised both arms over his head, his left falls to his side.
With the symptoms described the likely diagnosis is a stroke. The symptoms associated with a stroke are: numbness, tingling or weakness of face, arm or leg – especially on one side the body; confusion, trouble speaking or understanding speech; trouble swallowing, trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; and severe headache with no known cause. (National Stroke Association, 2014) There is an acronym FAST that is recommended to remember the signs of a stroke. Face – ask the person to smile and see if one ...view middle of the document...
Vital signs are monitored, blood tests are performed and an electrocardiogram (EKG or ECG) is performed. A CT scan of the brain is often performed. A CT scan is used to look for bleeding or masses within the brain. MRI scans may also be used. MRIs use magnetic waves rather than X-rays to image the brain. The MRI images are much more detailed than those from CT. However, MRIs do take longer and not all hospitals have them available, MRIs are not a first line of testing used. Computerized tomography with angiography is another test that may be used. Using dye that is injected into a vein in the arm, images of the blood vessels in the brain can give information regarding aneurysms or arteriovenous malformations. Other abnormalities of brain blood flow may be evaluated. CT angiography may be done at the same time as the initial CT scan to look for a blood clot within an artery in the brain. (onhealth.com, 2013)
Possible treatment options are drugs that work as clot-busters to help dissolve the blood clot that is causing the stroke. Alteplase (tPA) is a drug, that if given early within 4 ½ hours of onset you get better results and less potential for complications of bleeding into the brain. . Ideally 3 hours would be better. tPA is injected into a vein in the arm. tPA may reverse stroke symptoms in more than one-third of patients, but it can also cause bleeding in about 6%, which will make the stroke worse. Drugs to thin the blood are also sometimes used, like heparin and aspirin. Blood pressure is controlled, oxygen is usually provided, maintaining blood sugar levels, sometimes blood pressure and cholesterol medication is prescribed. Stop smoking is a must! Rehabilitation is also done after a stroke. Speech therapy is done to help relearn talking and swallowing; occupational therapy to regain function and dexterity in the arms and hands as possible; physical therapy to improve strength and walking; and family education to help them care for their loved ones at home. (onhealth.com, 2013)