General

Case Study for the weekend

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17 Jul 2016 - General
 

You are call to a medical ward to review a elderly man (unknown to you), with new onset of confusion, slurred speech, possible left facial droop, and left upper and limb weakness around 10pm, with patient was last seen well by nurse on 8pm. Patient was admitted initally around 10 days ago with pneumonia, possibly secondary to aspiration. Patient did has modified barium swallow test done earlier morning today by speech and language therapist, failed the test, and was kept nil per mouth since. Patient has background history of atrial fibrillation (on NOAC), hypertension, type 2 diabetes (on insulin), ischaemic heart disease. Vitals (respiraory rate, oxygen saturation, blood pressure, pulse, and temperature) are stable. Your examination showed the same finding as above. What is the most important bedside test to be done immediately ?? What is the potential diagnosis and differential ? What is the following management plan?

 

 

 

 

 

Hi Marinelle, you are definitely right. His GCS was around 12/15. Interestingly, his blood glucose (BM) was 1.0 !!!! Patient was fasting for the whole day. Dextrose solution was given immediately, which improve his symptoms over the time. The working diagnosis was a Stroke mimic , with hypoglycaemia. CT-Brain was done as well to ensure there is not a haemorrhagic stroke as patient is taking novel anticoagulation. CT-cerebral angiogram was performed together as well, to ensure there is no clo...
 (Total 117 words)
Hi You Yi, the most important bedside test to be done immediately is to assess the sensorium of the patient by GCS scoring and to check for the pupillary light reflex. For GCS scores 8 and below, the airway should be secured by endotracheal intubation. Since the patient is on NOAC for atrial fibrillation, it is important to rule out hemorrhagic stroke. Based on the given data, my impression would be a Acute hemorrhagic stroke of the right basal ganglia. If patient’s sensorium is depressed, manni...
 (Total 157 words)