Posted: March 16th, 2017
Neuro- Mary is a 64-year-old woman who presents to the emergency department (ED) with a new onset of numbness and lack of coordination in the left arm. She called 9-1-1 15 minutes after onset. Emergency medical response transported her to the hospital. On arrival in the ED, her symptoms have resolved. The patient’s blood pressure was 207/84 mm Hg; EKG reflecting atrial fibrillation with a ventricular rate averaging 110 bpm. Her NIHSS was 0, and she had blood glucose level of 181. Mary had a CT done that was negative for a hemorrhage. She was sent to MRI/MRA which showed widely patent vessels. An ECHO was also done and revealed an ejection fraction of 60%. Labs were drawn with significant findings noted: blood glucose, 181 mg/dL; creatine kinase (CK), 189; HbA1c 9.0%, cholesterol 130 mg/dL, triglycerides (TG) 56 mg/dL, high-density lipoprotein (HDL) 51 mg/dL, low-density lipoprotein (LDL) 168 mg/dL, creatinine 3 mg/dL, and INR of 2.5. Mary’s diagnosis is a transient ischemic attack. She is admitted to the telemetry floor for observation. During her hospitalization she is treated for hypertension and evaluated for uncontrolled diabetes. The patient’s past medical history includes type 2 diabetes, hypertension, obesity, hyperlipidemia, and gastroesophageal reflux disease (GERD). Mary is discharged to home the next day. 1. What risk factors for stroke does Mary present with, categorize as non-modifiable and modifiable. 2. Compare the pathophysiology and symptomatology of TIA and stroke. 3. Mary was diagnosed with a TIA, what testing needs to be completed to determine this? 3. What educational and medication needs does Mary need on discharge.
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