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A Stroke on the Head!

Topic: Adult

Created on Thursday, October 23 2008 by rednucleus

Last modified on Thursday, October 23 2008.

A 65-year-old man with long-standing hypertension and type II diabetes presents with left arm pyramidal weakness of grade 4 minus over the past 2 hours. Examination does not uncover any language or sensory problems. His non-contrast brain CT scan is unremarkable. Which one of the following statements is the correct one regarding this man's management?

A) MRI was better to be done in the first place

B) His fundoscopy is likely to reveal pale swelling of the optic nerve head

C) Aspirin is contraindicated

D) There is no need for doing carotid Doppler study

E) He is not eligible for receiving thrombolytic therapy

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This question was created on October 23, 2008 by rednucleus.
This question was last modified on October 23, 2008.

ANSWERS AND EXPLANATIONS

A) MRI was better to be done in the first place

This answer is incorrect.

Brain CT scan is superior to MRI in the acute stroke setting. (See References)


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B) His fundoscopy is likely to reveal pale swelling of the optic nerve head

This answer is incorrect.

The description is that of anterior ischemic optic neuropathy or early secondary optic atrophy (both of which are unlikely in our patient). His fundus may reveal diabetic and/or hypertensive retinal changes. (See References)


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C) Aspirin is contraindicated

This answer is incorrect.

Nothing in the patient's scenario points to a possible aspirin contraindication. Ischemic stroke patients needs secondary prophylaxis of their cerebral vascular event. (See References)


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D) There is no need for doing carotid Doppler study

This answer is incorrect.

Patients with ischemic stroke/TIA need a through cardiovascular assessment in the form of ECG, echocardiography, and carotid Doppler (according to their clinical context). (See References)


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E) He is not eligible for receiving thrombolytic therapy

This answer is correct.

Mild neurological deficit (like our patient's one)or rapidly improving ones belong to the long list of exclusion criteria for receiving rtPA administration. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
A Stroke on the Head!
Question ID: 102308072
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/23/2008
Modified: 10/23/2008
Estimated Permutations: 120