Ischemic Stroke Case Studies

Mrs. Sibley, your mother Mrs. Martens came to us about 4 days ago via ambulance with trouble speaking, difficulty swallowing and weakness of the right side. She showed signs of facial drooping and complained of a headache. Mr.Martens explained to us your mother was reaching in the cupboard for a dish when he right arm began to fall. She then sat down at the kitchen table, and proceeded to stand back up when she fell to the floor and was unable to stand without help. From there she showed a steady decline and the trouble speaking, difficulty swallowing, and weakness of the right side occurred within minutes. Mrs. Martens was alert and oriented, however showed some signs of confusion. We did not test how well she was able to walk due to the weakness
on her right side. When we tested her grip, it was significantly weaker on the left side. Her right pupil was also slow to respond to light and her right leg was limp. She had a very high blood pressure of 180/92, however, her breathing, temperature and pulse rate was normal.
We performed a chest X-Ray and a urine test, as well as an overall blood test to test PTT, which is how long it takes your blood to clot, and metabolism. We performed a test to see how well her lungs could move oxygen to the blood and CO2 from the blood. We done a CT scan which was clear of any brain bleeds that may have caused the stroke. Our Neurologist confirmed this to be a ischemic stroke due to a blood clot on the left side of the brain. When then diagnosed her with Hemiparesis which is weakness to the right side caused by the stroke, Hypertension which is high blood pressure, and ischemic stroke. We transferred Mrs.Martens to the ICU where she was given a medicine to help break down unwanted blood clots and was given mannitol through an IV to reduce any elevated pressure on the brain. A neuro check was performed every two hours. On day two, she unfortunately developed very low blood pressure, nausea and vomiting. She was then given something to control her nausea and vomiting and her saline drip was increased to keep her hydrated. After 5 hours, she was no longer vomiting and her blood pressure was back to
normal. We started her on what is called Aggrenox, which taken by mouth to reduce blood clots. By day three, she was exceptional and was moved to the medical floor where she was ordered Occupational and Physical Therapy. Neuro checks reduced to every 4 hours. On day four,
She has been doing well with the occupational and physical therapy. With someone helping her, she’s been using a walker. Gripping has improved. We have started her discharge plan. A rehabilitation facility is recommended, where as her occupational and physical therapy will continue. As well as speech therapy. Continue antipalelet therapy. I informed Mrs. Martens and husband to follow-up with her neurologist one week after discharge from Rehab.