Question

Neurologic Case Study 1

Mr. C (a 64-year-old Chinese faculty member teaching computer science) presents with headache, weakness, and numbness on his left extremities. He is by himself and a little confused, so his history is “sketchy.”

CC: “I had these problems this morning. I then seemed to improve, and then got worse. Now I’m getting scared.”

Past medical history:

• Hypertension
• Possible transient ischemic attacks last year per verbal history (patient was on vacation).
• Has been taking ASA 81 mg and amlodipine (Norvasc) 10 mg daily.

Physical exam:

• Blood pressure, 162/96
• Respiration rate, 26/min.
• Patient awake but confused
• Left foot slightly externally rotated, difficulty walking,
• Bilateral high-pitched carotid bruits
• Decreased sensation in left lower extremity.

Questions:

1. What National Guidelines are appropriate to consider?

2. Are there any legal/ethical considerations?

3. Are there any Healthy People 2020 objectives that you should consider?

Answer 1

1.National guidelines for stroke management

1. Assess it ischemic or hemorrhagic
2. Icu care
3. IV tissue plasminogen activators
4. Drugs to control blood pressure
5. Emergency surgical interventions in case of hemorrhagic stroke

2. The legal and ethical consideration in this situation is explain well the condition of the patient to the relatives.Informed consent for every procedure.

3.In healthy people 2020 guidelines stroke comes under the category HEART DISEASE AND STROKE (HDS).Under this the stroke guidelines are included in HDS3 that is reduce stroke death. The guidelines emphasis on preventing stroke by reducing the risk factors and also early detection and management.