Case Study:  Stroke


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?


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?

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