Stroke Case Studies
Case Study 1
• 72 yo female collapses at home while eating
dinner with her daughter. EMS brings the
patient to your ER and you note the following:
garbled speech, right sided hemiplegia, able to
briskly follow commands with left side, and
able to write answers to questions. Vitals: BP
177/90, P 88 bpm and irregular, RR 18, O2
95% on room air
What is your FIRST action?
A. Administer IV tPa
B. Give 10 mg IV
C. Obtain STAT head CT
D. Obtain STAT brain
Which artery is likely affected?
A. Right Middle Cerebral
Artery (MCA)
B. Left Middle Cerebral
Artery (MCA)
C. Right Anterior Cerebral
Artery (ACA)
D. Left Anterior Cerebral
Artery (ACA)
What is the name of the patient’s language
A.Adam’s Aphasia
B.Wernicke’s (receptive)
C.Broca’s (expressive)
D.Global Aphasia
Case Study 2
Mrs. Liken is a 48 yo female who presents to the
ED with “the worst headache of her life”. She
states the pain is the worst in the back of her
head and her neck. Past medical hx: HTN
(noncompliant) and tobacco use. Vitals: 174/88,
103, 99% on room air, RR 22
What is your #1 differential diagnosis?
A. Intracerebral
B. Subdural Hematoma
C. Epidural Hematoma
D. Subarachnoid
Case Study 2
Given the confirmed diagnosis of SAH, what is
considered the gold standard for diagnosing an
aneurysmal SAH?
While awaiting intervention (coiling or clipping),
what is the number one priority ?
A. Make the patient NPO for
the procedure
B. Assure adequate
hydration given the large
contrast load
C. Obtain echocardiogram
to assess for myocardial
D. Strict blood pressure
control to prevent rerupture of the aneurysm
Case Study 3
EMS brings a 59 yo homeless male to your
Emergency Department. No known past medical
history is known. EMS was called when the
patient was found in a park on the ground
shaking his left arm and leg. Positive loss of
consciousness was briefly noted.
Case Study 3
The patient regains consciousness in the
ambulance but is substantially weaker on his left
side. He states this is new. EMS initiates CODE
STROKE per protocol. CT of head is negative for
hemorrhage and the patient is unable to receive
an MRI 2/2 bullet fragments.
Should you consider the patient for IV tPa?
A. Yes
B. No

Stroke Case Studies - Vanderbilt University Medical …