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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify risk factors for ischemic stroke.

  • Discuss the role of thrombolytics in the management of acute ischemic stroke.

  • Formulate an appropriate patient-specific drug regimen for the treatment of an acute ischemic stroke.

  • Discuss the approach to multidisease state management for the secondary prevention of ischemic stroke, including the management of hypertension, dyslipidemia, and the use of antiplatelet agents.

  • Educate a patient regarding secondary stroke prevention strategies.

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PATIENT PRESENTATION

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Chief Complaint

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“My dad is having trouble talking and seems to be losing feeling in his left arm and leg.”

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HPI

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Marvin Palmer is a 57-year-old man who was brought to the ED by his son at 10 am after experiencing left arm numbness, slurred speech, and dizziness. His son states that the two of them were enjoying their typical Saturday morning golf outing at the country club when Mr Palmer, on teeing off on hole 6 at 9:30 am, dropped his golf club and went down on one knee. Mr Palmer’s words were “slow and disjointed” according to his son who immediately called 9-1-1. While in the ED, Mr Palmer began to have a left-sided facial droop. He admitted noticing minor dizziness and slight tingling in his left hand at 8 am, both of which resolved soon thereafter. He assumed these were symptoms due to low blood pressure and therefore opted not to take his blood pressure medications this morning.

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PMH

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  • HTN, diagnosed 10 years ago

  • Dyslipidemia

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FH

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Both parents alive and relatively healthy. Sister, age 62, also has HTN. Son, age 31, has type 1 DM.

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SH

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Married, lives with wife and three children. Occasional recreational beer or wine consumption. Denies tobacco use.

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Meds

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  • Amlodipine 2.5 mg PO daily

  • Simvastatin 10 mg PO daily

  • Chlorthalidone 25 mg PO daily

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All

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Shellfish (hives).

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ROS

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Mild blurry vision, but no double vision, loss of vision, or oscillopsia.

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Physical Examination

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Gen
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Slender Caucasian man lying in bed in no acute distress, responsive with occasionally slurred speech

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VS
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BP 192/98, P 70, RR 19, T 98.6°F, O2 sat 97% on RA; Wt 80 kg, Ht 6′0″

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Skin
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Warm, dry

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HEENT
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PERRLA, EOMI; no nystagmus, exudates, hemorrhages, or papilledema; mild left-sided facial droop. Normal hearing acuity bilaterally

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Neck
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(–) Carotid bruits, (–) lymphadenopathy

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Chest
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Lungs ...

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