Ischemic Stroke in Young Adults
For this discussion, Case Study 3 was reviewed. The patient is a 50-year-old African American male with a history of poorly controlled diabetes, hypertension, and hyperlipidemia. He presented with complaints of dizziness, left arm weakness, and fatigue. Physical exam demonstrates mild dysarthria, mild left-sided facial weakness, and left-sided homonymous hemianopsia. He follows commands and has no other symptoms. There is no time frame or time of onset of symptoms given. Primary Diagnosis The primary diagnosis for this patient is acute ischemic stroke. He has unilateral weakness and hemianopsia that is unilateral as well. He also has dizziness and fatigue. These are all common symptoms of stroke presentation. He has several risk factors such as African American race, male gender, history of diabetes, hypertension, and hyperlipidemia (Zhang, et al., 2020). Treatment would consist of using the risk stratification ABCD score. This patient scores a 6, giving him over an 8% risk of worsening stroke within 48 hours. Sending this patient to the emergency department for the further evaluation would be prudent (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Ischemic stroke can cause severe disability and even death, therefore timely evaluation and treatment are critical (Onder, Cankurtaran, Ozyurek, & Arslan, 2020). Differential Diagnosis Some differential diagnoses for this patient would be a transient ischemic attack (TIA), hypertensive encephalopathy, and hemorrhagic stroke. TIA presentation is very similar to stroke presentation. TIA symptoms usually resolve within 24 hours. Since the time of onset is not known, referral to the Emergency Department is still prudent in these cases for evaluation and treatment. Hypertensive encephalopathy would be a possible diagnosis in this patient as well. A good place to start would be obtaining a blood pressure reading to see if the patient’s blood pressure is elevated.Ischemic Stroke in Young Adults
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Dizziness is a classic presenting symptom, as is headache, which this patient does not complain of. Visual changes are common in hypertensive encephalopathy as well. Again, a prompt evaluation at a hospital emergency department which includes a CT or MRI of the brain would be a good tool to rule out or rule in a stroke (Sviridova, et al., 2019). Hemorrhagic stroke would be another possible diagnosis for this patient. A headache would be a symptom that would differentiate between a hemorrhagic stroke and an ischemic stroke. This patient did not complain of a headache. Evaluation and treatment in the emergency department are of utmost importance to differentiate between the two types of stroke. A CT or MRI is needed quickly to determine appropriate treatment (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). References: Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th Ed.). St. Louis, MO: Elsevier Onder, H., Cankurtaran, M., Ozyurek, O., & Arslan, G. (2020). the neutrophil-to-lymphocyte ratio may have a role in the differential diagnosis of ischemic stroke. Neurology Asia, 25(2), 93–101. Sviridova, N. K., Trufanov, E. O., Pedachenko, E. G., Chupryna, H. M., Zhhilova, N. O., & Bondarenko, H. S. (2019). Hypertensive Encephalopathy. Clinical Characteristics, Diagnostic Criteria. Romanian Journal of Neurology, 18(2), 57–64. Zhang, Q., Liu, Y., Jiang, M., Liu, Y., GU, S., Tong, H., & Liu, H. (2020). Temporal Trends in the Risk Factors and Clinical Characteristics of Ischemic Stroke in Young Adults. Journal of Stroke and Cerebrovascular Diseases, 29(8), 104914. doi:10.1016/j.jstrokecerebrovasdis.2020.104914 please response tm Ischemic Stroke in Young Adults
