A.R., a 62-year-old man, was admitted to the ER with right hemiplegia and aphasia. He had a history of hypertension and recent transient ischemic attacks (TIAs), yet was in good health when he experienced a sudden onset of right-sided weakness. He arrived in the ER via ambulance within 15 minutes of onset and was received by a member of the hospital's stroke team. He had a rapid general assessment and neuro exam, including a Glasgow coma scale (GCS) rating, to determine his candidacy for fibrinolytic therapy.
He was sent for a noncontrast CT scan to look for evidence of hemorrhagic or ischemic stroke, post–cardiac arrest ischemia, hypertensive encephalopathy, craniocerebral or cervical trauma, meningitis, encephalitis, brain abscess, tumor, and subdural or epidural hematoma. The CT scan, read by the radiologist, did not show intracerebral or subarachnoid hemorrhage. A.R. was diagnosed with probable acute ischemic stroke within 1 hour of onset of symptoms and cleared as a candidate for immediate fibrinolytic treatment.
He was admitted to the NICU for 48-hour observation to monitor his neuro status and vital signs. He was discharged after 3 days with a prognosis of full recovery.
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