Hemiparesis: The Emerging Role of the Emergency Physician in Stroke Management Edward Sloan, MD, MPH Associate Professor Department of Emergency Medicine University of Illinois College of Medicine-Chicago Chicago, IL. Objectives. Present clinical case history Review Emergency Department H&P
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Hemiparesis: The Emerging Role of the Emergency Physician in Stroke Management Edward Sloan, MD, MPHAssociate ProfessorDepartment of Emergency MedicineUniversity of Illinois College of Medicine-ChicagoChicago, IL
A 70 year old female developed acute onset of left arm weakness that lasted approximately 15 minutes and then gradually resolved. She chose to ignore the event and did well until three weeks later she developed complete paralysis of the left arm and pronounced weakness of the left leg; neither resolved and approximately 90 minutes into the event she called EMS. Past medical history included hypertension and COPD. Medications: metoprolol, hydrochlorthiazide, and atrovent.
On exam, BP 200/120, P 68, RR 18, T 98, and pulse oximetry showed 94% saturation. The patient appeared alert though responses were slow. The patient had bilateral carotid bruits, clear lungs, and a regular rate and rhythm. There was no facial asymmetry, upper extremity motor 5/5 on the right and 0/5 on the left; lower extremity motor 5/5 on the right and 3/5 on the left. Sensory was intact to light touch and pinprick. DTRs were 2/2 on the left and 0/2 on the right. Planter reflex was downgoing on the right and upgoing on the left.
a. There are three major categories: thrombotic, embolic, and hypoperfusion.
b. The majority of all strokes are caused by vessel thrombosis.
c. The symptoms of ischemic stroke develop over minutes to hours.
d. The most common source of emboli are the heart and major vessels.
e. Middle cerebral artery infarction is associated with ipsilateral weakness and numbness.