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“I tried to speak but could not get the words out.”
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History of Present Illness
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73-year-old woman experienced sudden weakness in her right hand and difficulty speaking while at home with her husband. She has had several episodes of difficulty speaking and tingling in her right hand within the past two weeks that resolved within 15 minutes. The paramedics were called, and she was taken to the nearest stroke unit via ambulance.
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What nonmodifiable and modifiable risk factors for ischemic stroke are evident in this patient?
Hint: See Etiology and Classification and Table 12-1 in PPP
What supportive care is appropriate for this patient?
Hint: See Treatment in PPP
Based on treatment guidelines, is this patient a candidate for thrombolytic therapy?
Hint: See Treatment, Figure 12-1, and Table 12-4 in PPP
How should alteplase be administered and monitored acutely in the clinical setting?
Hint: See Treatment and Table 12-5 in PPP
Based on treatment guidelines, is this patient a candidate for endovascular therapy?
Hint: See Treatment, Figure 12-1, and Table 12-4 in PPP
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What are the available options for antiplatelet therapy for secondary stroke prevention in this patient?
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Hint: See Treatment in PPP
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Stroke is the second leading cause of disability and death globally with the highest burden of disease seen in low- and middle-income countries. The global incidence of ischemic stroke in 2017 was 101.3 (91 – 113.6) per 100,000 population. The utilization of rtPA is approximately 10 – 15% in high-income countries compared to less than 2% in low- and middle-income countries. Treatment of ischemic stroke with rtPA and/or mechanical thrombectomy have been shown to be both effective at preventing disability and death and cost-effective. Global efforts to improve access to stroke treatments are ongoing and critically important to reduce the burden of disease of stroke.
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Saini
V, Guada
L, Yavagal
DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology 2021;97 (20 Suppl 2) S6–16; DOI: 10.1212/WNL.0000000000012781.
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Powers
WJ, Rabinstein
AA, Ackerson
T,
et al.; on behalf of the American Heart Association Stroke Council. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50:e344–e418 ...