Stroke Scenario
Task 1: In this this evolving case, what information most assists medical staff to distinguish the type of stroke that Julia has experienced? Explain the difference that the type of stroke would make to the pharmacological interventions.
Task 2: Outline the pathophysiological stages between complete arterial occlusion and irreversible cell death.
Clinical presentation
Julia?s friend has brought her to the emergency department because she noticed that Julia ?wasn?t quite right?, presenting as mildly altered cognition with nausea and a worsening headache.
History ? about the patient
Julia Pyne is a fit active 62yo lady. She lives alone and works part-time in her life long career of teaching. She has always been well, except for moderate primary hypertension which has been difficult to control. She has trialled a number of medications with varying success. She also self-medicates with ? a soluble aspirin (150mg/day).
Initial Physical Examination
A physical examination reveals the following:
? Blood pressure: 178/92 mmHg
? Heart rate: 78 bpm
? Respiratory rate: 24
? Temperature: 37?C
? GCS: 13
? R) Hand paresis
? Dysarthria
Shortly after presentation, Julia experienced a seizure. An MRI was requested.
Immediate interventions and investigations
? Peripheral line inserted for intravenous therapy and medications
? Inotropic therapy
? Medication to promote blood clotting
? Phenytoin
? Nil per oral
FBE, BGL, Lipids, U & E were all normal
Questioning elicited that Julia had been bushwalking with friends on the weekend when she slipped and hit her head hard into a branch. She?d recovered quickly and felt no immediate ill effects.
Progress and follow-up
Julia spent a fortnight in hospital and was discharged with only a continuing slight deficit in her right hand function.


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