Case
Study: Stroke
INITIAL HISTORY:
Ø
76
year old man, slightly confused
Ø
Wife
describes symptoms starting 30 minutes ago
Ø
Sudden
onset of difficulty getting his mouth to form words; speech is slurred
Ø
Face
and mouth numb; tongue feels ‘thick’
Ø
Unable
to hold his coffee cup in his right hand
Ø
Right
leg weak; needs to hold on to the table to stand
Question 1: What is your differential diagnosis based
on the information you have now?
Question 2:
What other
questions would you like to ask?
ADDITIONAL HISTORY:
Ø
History
of essential hypertension
Ø
Has
not been taking his thiazide diuretic because it makes him feel ‘bad’
Ø
Was
told he has high cholesterol but has not returned to see his primary care
provider
Ø
Has
experienced several brief spells of right-sided weakness which resolved in a
few minutes; thought this was his arm falling asleep
Ø
No
head trauma or recent infections
Ø
Family
history; mother died of stroke, father died of acute myocardial infarction
(AMI)
Ø
Smokes
1 pack/day of cigarettes for the past 30 years
Ø
Sedentary
lifestyle
Question 3:
Now what do you
think?
Expert Solution Preview
Introduction:
Based on the given case study of a 76-year-old man presenting with sudden onset speech difficulties and weakness, accompanied by facial numbness, there is a possibility of an underlying neurological disorder. As a medical professor responsible for creating assignments and answers for medical college students, I would consider the following differential diagnoses and further information to be able to provide appropriate care.
Answer to question 1:
The given symptoms indicate a possible stroke, also known as a cerebrovascular accident (CVA). However, other conditions such as brain tumors, seizures, Bell’s palsy, or intoxication could also produce similar symptoms.
Answer to question 2:
To further evaluate the patient’s condition, the following questions are necessary to develop a more accurate diagnosis:
– What time did the patient first experience the symptoms?
– Is there a history of any neurological disorders?
– Has there been any recent trauma, surgery or infections?
– Is there a past medical history of hypertension or hyperlipidemia?
– Does the patient have a history of smoking or alcohol consumption?
Answer to question 3:
After taking into account the additional history provided, there is a higher chance the patient is suffering from a stroke. The brief spells of right-sided weakness that resolved in a few minutes should have been investigated earlier. Family history of stroke and AMI, as well as smoking and a sedentary lifestyle, may have contributed to the development of atherosclerosis, putting the patient at risk for a cerebrovascular accident. The patient may have also developed a transient ischemic attack (TIA), which precedes a stroke.
In conclusion, the differential diagnosis of stroke should be considered to provide immediate medical attention. A thorough investigation of the patient’s history and vital signs is essential to determine the appropriate course of treatment.