What abnormalities if any can you see?
Category: Advancing Modules
06: Non contrast CT head
What abnormalities if any can you see?
Case 06
Clinical history and examination
Age: 36 years, Female.
Time of presentation: 14:00
History of event
- Symptoms: 2 days of right headache, pain in neck – sudden onset left sided weakness
- Current time interval since last known well: 1 hr (60 mins)
Past medical history
- Migraine with aura
- 4 days post normal vaginal delivery with epidural
Relevant medications
- None regular
- Sumatriptan as required
Relevant social history
- Living circumstance: at home with husband
- Prior function and care needs: independent
- Work/hobbies: on maternity leave from accountancy job, triathlons
Examination
- Pulse: 100 reg, BP 110/70
- Neuro:
- Handedness: right handed
- NIHSS: 14
- Deficits: left facial droop, weakness of left arm and leg, left neglect
Investigations requested with non imaging results
- None
05: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
05: Update and decisions
Now 2 hrs 55 mins (175 mins) since onset, BP currently 200/80, NIHSS unchanged at 20.
05: CT Angiogram
What abnormalities if any can you see?
05: Non contrast CT head
What abnormalities if any can you see?
Case 05
Clinical history and examination
Age: 86 years, Male.
Time of presentation: 10:30
History of event
- Symptoms: unable to speak, right sided weakness
- Current time interval since last known well: 2 hrs 30 mins (150 mins)
Past medical history
- Previous ischaemic stroke with residual mild left sided weakness
- Recent non stemi MI
Relevant medications
- Aspirin and Clopidogrel
- Statin
- ACE I
- Diuretic
Relevant social history
- Living circumstance: at home with daughter
- Prior function and care needs: can walk in house, electric buggy out doors, can wash, dress but needs some help
- Work/hobbies: retired, watches racing on TV, enjoys grandchildren
Examination
- Pulse: 76, BP 205/85
- Neuro:
- Handedness: right handed
- NIHSS: 20
- Deficits: severe aphasia, severe right face, arm and leg weakness, likely hemianopia
Investigations requested with non imaging results
- None
04: Experienced colleagues decisions
Select the crosses for each colleagues decision and rationale
04: Update and decisions
Now 1 hr 40 mins (100 mins) since onset, BP currently 170/74, NIHSS improved from 12 to 9 – improved power in arm and leg.
