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- Sep 17, 2014
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Case:
70+ yo F w/ hx of CVA 7yrs prior w/ residual mild expressive aphasia presents w/ severe expressive and receptive aphasia and severe headache. Onset 1hr prior to arrival, and the onset was actually witnessed by family member. The family member at bedside states she went from calmly eating her breakfast to placing her head in her hands in obvious, severe discomfort with an inability to communicate. The only thing the patient can clearly state without much provocation is that "it hurts" while pointing to her head. The patient has no history of headaches. She does have a hx of HTN and DM. She is not on any anticoagulation. She does take a baby aspirin daily, no plavix.
VS: HR-92, BP-155/100, RR-16, Temp-98.2 (Glucose: 105)
Physical exam
General: Alert but in moderate distress
HEENT: EOMI, PERRL, all otherwise unremarkable
CV: RRR, no murmur, 2+ pulses in all extremities
Resp: Unremarkable
GI: Unremarkable
Skin: unremarkable
Neuro: A&O to person only, unable to state current month or year, where she is at, or why she is here in hospital. Patient has difficulty following simple commands requiring multiple attempts before she is able to comprehend the command that is asked. She has significant difficulties communicating. No dysarthria. She has 3/5 strength in RLE and 4/5 strength in all other extremities. Patient does localize to pain b/l, but unable to communicate for accurate sensory exam.
Imaging
CT head: L sided old infarct, otherwise, no evidence of bleed or acute changes
What are you doing next?
70+ yo F w/ hx of CVA 7yrs prior w/ residual mild expressive aphasia presents w/ severe expressive and receptive aphasia and severe headache. Onset 1hr prior to arrival, and the onset was actually witnessed by family member. The family member at bedside states she went from calmly eating her breakfast to placing her head in her hands in obvious, severe discomfort with an inability to communicate. The only thing the patient can clearly state without much provocation is that "it hurts" while pointing to her head. The patient has no history of headaches. She does have a hx of HTN and DM. She is not on any anticoagulation. She does take a baby aspirin daily, no plavix.
VS: HR-92, BP-155/100, RR-16, Temp-98.2 (Glucose: 105)
Physical exam
General: Alert but in moderate distress
HEENT: EOMI, PERRL, all otherwise unremarkable
CV: RRR, no murmur, 2+ pulses in all extremities
Resp: Unremarkable
GI: Unremarkable
Skin: unremarkable
Neuro: A&O to person only, unable to state current month or year, where she is at, or why she is here in hospital. Patient has difficulty following simple commands requiring multiple attempts before she is able to comprehend the command that is asked. She has significant difficulties communicating. No dysarthria. She has 3/5 strength in RLE and 4/5 strength in all other extremities. Patient does localize to pain b/l, but unable to communicate for accurate sensory exam.
Imaging
CT head: L sided old infarct, otherwise, no evidence of bleed or acute changes
What are you doing next?