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    Stroke and Hypertension

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    Khessie Laye Garcia Jacinto
    A 67-year-old African American man presented to the emergency room with sudden onset weakness in his right arm. He had a history of hypertension and hyperlipidemia. On examination, he had right-sided weakness, facial droop and slurred speech. Imaging showed an ischemic stroke in the left middle cerebral artery territory. He was found to have moderate carotid stenosis on both sides. His past medical history and imaging were consistent with an ischemic stroke likely due to hypertension and carotid artery disease.

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    Stroke and Hypertension

    Uploaded by

    Khessie Laye Garcia Jacinto
    113 views4 pages
    A 67-year-old African American man presented to the emergency room with sudden onset weakness in his right arm. He had a history of hypertension and hyperlipidemia. On examination, he had right-sided weakness, facial droop and slurred speech. Imaging showed an ischemic stroke in the left middle cerebral artery territory. He was found to have moderate carotid stenosis on both sides. His past medical history and imaging were consistent with an ischemic stroke likely due to hypertension and carotid artery disease.

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    A 67-year-old African American man presented to the emergency room with sudden onset weakness in his right arm. He had a history of hypertension and hyperlipidemia. On examination, he had right-sided weakness, facial droop and slurred speech. Imaging showed an ischemic stroke in the left middle cerebral artery territory. He was found to have moderate carotid stenosis on both sides. His past medical history and imaging were consistent with an ischemic stroke likely due to hypertension and carotid artery disease.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    113 views4 pages

    Stroke and Hypertension

    Uploaded by

    Khessie Laye Garcia Jacinto
    A 67-year-old African American man presented to the emergency room with sudden onset weakness in his right arm. He had a history of hypertension and hyperlipidemia. On examination, he had right-sided weakness, facial droop and slurred speech. Imaging showed an ischemic stroke in the left middle cerebral artery territory. He was found to have moderate carotid stenosis on both sides. His past medical history and imaging were consistent with an ischemic stroke likely due to hypertension and carotid artery disease.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    ISCHEMIC STROKE & HYPERTENSION

    PATIENT PRESENTATION

    Chief Complaint

    “My right arm feels like it’s frozen. I can barely move it.”

    HPI (History of patient illness)

    Carson Johnson is a 67-year-old African-American man who presents to the emergency room at 8:45 AM
    after noticing a sudden onset of weakness in his right arm. He woke up at 7:15 AM and went to the
    bathroom to brush his teeth. While walking from the bathroom to the kitchen, he noticed general
    weakness and had trouble saying “good morning” to his son, Willis, with whom he lives. His son
    immediately brought him to the ER. While in the ER, he started experiencing some dysarthria and began
    to have a rightsided facial droop. He denied any dizziness, vomiting, or headache. He was previously
    diagnosed of cardiac arrythmia and currently been on diltiazem therapy.

    PMH (Past Medical History)

    Hypertension – on medications, diagnosed 10 years ago

    Hyperlipidemia

    Two different TIAs in the past, last in 2002

    FH (Family History)

    Father passed away at age 87 from a stroke; mother passed away from “old age” at age 82. Brother,
    age 61, also has HTN. Son, age 34, has DM.

    SH

    Denies ETOH use, admits to occasional cocaine use, quit smoking 20 years ago. Lives with son.

    Meds

    Ramipril 5 mg po daily – ACE Inhibitor (pang highblood)

    Atorvastatin 10 mg po daily – HMG-coA reductase (hyperlipidemia)


    Atenolol 50 mg po daily (

    Aspirin EC 81 mg po daily (blood-thinner/anticoagulant)

    All

    PCN Percutaneous nephrostomy (PCN)/ Penicillin (rash), adhesive tape

    ROS (review of symptoms.)

    Denies headache. Vision is blurry.

    Physical Examination

    Gen (General)

    WD AAM lying in bed, responsive but sluggish; looks tired. Speech

    is slurred.

    WD AAM lying in bed, responsive but sluggish; looks tired. Speech

    is slurred.

    VS vital signs.

    BP 172/92, P 92, RR 21, T 98.6°, O2 Sat 94% on room air; Wt 90 kg, Ht 5'8''

    Skin

    Warm, dry

    HEENT

    PERRLA, EOMI; no nystagmus, exudates, hemorrhages, or papilledema; right-sided facial droop

    Neck

    (+) carotid bruits on the left side, (–) lymphadenopathy

    Chest
    Lungs clear to auscultation bilaterally

    CV (Cardiovascular)

    RRR (heart rate and rhythm) , S1 & S2 normal, no S3 or S4

    Abd

    Soft, non-tender, non-distended, (+) BS

    GU (GENITOURINARY)

    Deferred

    MS/Ext

    RUE: 2/5; RLE 4/5; LUE: 5/5; LLE: 5/5

    Good pulses, no CCE; DTR: 2+ throughout, normal Babinski reflex

    Neuro

    A & O × 3; (+) dysarthria, right-sided facial droop

    Labs

    Na 138 mEq/L WBC 6.2 × 103/mm3 Total Cholesterol 207 mg/dL

    K 3.8 mEq/L Hgb 16.9 g/dL

    Cl 103 mEq/L Hct 51.3% LDL-C 114 mg/dL

    CO2 29 mEq/L Plt 242 × 103/mm3 Triglycerides 179 mg/dL

    BUN 18 mg/dL aPTT 26.3 sec

    SCr 0.9 mg/dL HDL-C 45 mg/dL

    Glu 109 mg/dL

    Head CT scan: (–) hemorrhage, left-sided middle cerebral artery

    infarct (Fig. 18-1)


    Head CT scan without contrast: (–) hemorrhage, leftsided

    middle cerebral artery infarct.

    Carotid dopplers: reduced flow, moderate to severe carotid stenosis; 65% stenosis of right carotid, 50%
    stenosis of left carotid

    Echocardiogram: no evidence of LV thrombus, ejection fraction 55–60%; overall unremarkable

    EKG: Tachycardic sinus rhythm

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