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Lucinda feels somewhat relieved and tells the nurse and attending ER physician that both of Mario’s parents passed away from myocardial infarctions when they were in their late 60s.She adds that Mario is a smoker, usually smoking about a pack and half each day.
Diagnosis: Acute ischemic stroke caused by distal left internal carotid artery occlusion, with salvageable penumbral tissue and a persistent large-vessel occlusion. Saver is Director of the UCLA Stroke Centre and Professor of Neurology at University of California Los Angeles, Los Angeles, CA, USA. Comments on Medscape are moderated and should be professional in tone and on topic.
Management: Neuroprotective study agent (total dose of 20 g intravenous Mg SO B. Buck is a Fellow of the Division of Neurology in the Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada. You must declare any conflicts of interest related to your comments and responses.
When his grating headaches began intensifying, Mario and his wife chalked it up to the recent stressors in his life.
He had just turned 66 and had been newly-diagnosed with diabetes mellitus.
When patients are treated by medical professionals soon after a stroke occurs, permanent brain tissue damage or death may be avoided.
The nurse informs Lucinda that the major identified risk factors associated with an increased risk of stroke include: * Age (older than 65 yrs) * Hypertension * Family or personal history of cardiovascular disease * Smoking * Obesity.Background: An 83-year-old woman with a history of hypertension and dyslipidemia developed acute onset of impaired speech and comprehension, and right-sided weakness.Her previous medical history was notable for hyperthyroidism and a curative remote mastectomy for breast cancer.Initial examination showed global aphasia, right homonymous hemianopia, right hemiplegia, and hemisensory loss. Saver is Principal Investigator of the NIH FAST–MAG Trial, is an investigator in the NIH MR RESCUE, IMS 3 and CLEAR trials, is on the Scientific Advisory Board and Speaker's Bureau for Boehringer Ingelheim (secondary prevention) and has received speaking honoraria from Concentric Medical. Please see our Commenting Guide for further information.Investigations: Physical examination, laboratory tests, noncontrast head CT scan, multimodal brain MRI scan, catheter cerebral angiogram, echocardiogram, continuous cardiac monitoring. Buck is supported by a fellowship award from the Heart and Stroke Foundation of Canada. We reserve the right to remove posts at our sole discretion.He asks the case manager to meet with Lucinda, and then with Mario when he is fully conscious.When the attending case manager speaks with the wife, she asks about insurance coverage and verifies that the patient has adequate coverage through his employer’s health insurance plan.Also known as cerebrovascular accident (CVA), stroke occurs when part of the brain is deprived of adequate oxygen due to an arterial blockage or rupture.It accounts for more than 160,000 annual deaths in the United States, making stroke the third leading cause of death, following closely behind heart disease and cancer. There are two kinds of CVAs or stroke: an ischemic stroke (occurs when the blood supply to the brain is interrupted, usually by a blood clot) or a hemorrhagic stroke (happens when there is bleeding in or around the brain).He disliked physical activity and his idea of “exercise” was watching sports on television. When the nurse asks the wife if he had experienced any unusual symptoms prior to being admitted to the hospital, she tells her that Mario had complained of escalating migraines a couple of days ago.But she tells the nurse that this was not unusual since Mario had suffered migraines ever since his late thirties when he immigrated to the United States from his native Puerto Rico.