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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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History of hypertension, blurred vision, speaking difficulty, dizziness, high BP. Treatment?

Mrs Smith is 82 years old and lives in her own home. She receives assistance
with physical chores such as shopping and cleaning, but is still able to do light
tasks such as tidying the house and cooking her own meals. She is not
overweight, but does not undertake any exercise activities. She has a history
of hypertension and her blood pressure measured today is 145/90. She has
not been diagnosed with diabetes or coronary heart disease. Mrs Smith has
presented today after experiencing an episode of blurred vision, difficulty
speaking and dizziness. She did not lose consciousness and did not
experience muscle weakness. The episode commenced about an hour ago
and lasted for approximately 20 minutes. She was not asleep when the symp
toms commenced. After arriving at hospital, a CT scan was performed and no
tumour was observed. An MRI scan is about to be performed.
1. Based on the information in the case study, which type of stroke is Mrs
Smith likely to have suffered?
2. Identify which features from Mrs Smith’s case notes (the information above)
are risk factors for the development of stroke.
3. Would it be appropriate to consider treating this patient with tissue plasmin
activator (tPA, alteplase)? How does this drug work?
4. After Mrs Smith has been stabilised and is ready to be discharged home,
what type of information should she be given to assist in preventing further
stroke.
Fri, 27 Sep 2013
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Cardiologist 's  Response
Dear Sir/ Madam
Thanks for your query.
1. The history given is suggestive of TIA (transient ischemic attack) of possibly posterior circulation.
2. This is itself is similar to a stroke pathologically. She has high risk of developing a full fledged stroke.
3. No, Not now. Since the CT scan is negative & MRI has not been done and her symptoms has reversed too, thrombolytic therapy can not be recommended as yet. This dug dissolves a clot, in the blood vessel, responsible for stopping blood supply to a particular part of brain.
4. She should have good control of her BP/ cholesterol. Such patients should also receive anti-platelet drugs and statins.
Sincerely
Sukhvinder
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History of hypertension, blurred vision, speaking difficulty, dizziness, high BP. Treatment?

Dear Sir/ Madam Thanks for your query. 1. The history given is suggestive of TIA (transient ischemic attack) of possibly posterior circulation. 2. This is itself is similar to a stroke pathologically. She has high risk of developing a full fledged stroke. 3. No, Not now. Since the CT scan is negative & MRI has not been done and her symptoms has reversed too, thrombolytic therapy can not be recommended as yet. This dug dissolves a clot, in the blood vessel, responsible for stopping blood supply to a particular part of brain. 4. She should have good control of her BP/ cholesterol. Such patients should also receive anti-platelet drugs and statins. Sincerely Sukhvinder