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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of acute ischemic stroke

  • Identify risk factors for ischemic stroke in a patient and provide appropriate patient education

  • Determine whether thrombolytic therapy is indicated in a patient with acute ischemic stroke

  • Develop an appropriate patient-specific therapeutic plan for acute ischemic stroke

  • Develop an appropriate therapeutic plan for outpatient management of a patient with ischemic stroke, including an appropriate agent to prevent stroke recurrence

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PATIENT PRESENTATION

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Chief Complaint

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"I just could not get the words out. I tried to speak, but nothing would come out."

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History of Present Illness

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Catherine Smith is an 81-year-old Caucasian woman who was taken by the paramedics to the local hospital after experiencing weakness in her right hand and difficulty speaking during dinner with her neighbors. Her neighbors noted that she was having difficulty holding her fork and her speech seemed jumbled, so they immediately called the paramedics. She arrived in the emergency department within 90 minutes of the onset of her symptoms. She has been feeling tired and anxious since the death of her husband 4 months ago. Her appetite has been poor and she has lost 11 lb (5 kg) during this time. In the past 2 weeks, she has had several episodes where she experienced tingling in the fingers of her right hand and difficulty speaking; however, these episodes resolved within 15–20 minutes. She previously experienced these symptoms in 2007.

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Past Medical History

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HTN for 18 years

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PVD diagnosed in 2003

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Anemia diagnosed 6 months ago

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Anxiety diagnosed 2 months ago

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Family History

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Both parents are deceased. She has no siblings. She has two adult sons who are healthy.

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Social History

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She worked as an administrative assistant, and is retired for 22 years. She has two children aged 51 and 45 years.

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications (Current)

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Lisinopril/HCTZ 10/12.5 mg, 1 tablet PO every morning

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Atenolol 25 mg, 1 tablet PO every evening

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Aspirin 325 mg, 1 tablet PO every morning

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Ferrous gluconate 300 mg, 1 tablet PO every morning with food

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Citrucel fiber shake, 1 shake PO daily

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Alprazolam 0.25 mg, 1 tablet PO 3 times daily PRN anxiety

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Medications (Prior)

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Cilostazol 50 mg, 1 tablet PO twice daily, discontinued due to diarrhea

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Review of Systems

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Denies headache; (−) blurred vision; (−) dizziness; has had difficulty ambulating ...

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