A 75-Year-Old Woman with a Hemispheric Stroke 英文参考文献.docVIP

Open access, freely available online Learning Forum A 75-Year-Old Woman with a Hemispheric Stroke Stavros K. Kakkos, George Geroulakos* D E S C R I P T I O N o f C A S E A hemispheric stroke (slurred speech and left facial 75-year-old right-handed woman presented with a two-day history of symptoms suggestive of a right and left arm weakness). She had no previous cerebrovascular symptoms, such as symptoms of a previous transient ischaemic attack or amaurosis fugax (loss of vision in one eye due to a temporary lack of blood ?ow to the retina). Past medical history included long-standing hypertension and chronic obstructive pulmonary disease. She was on amlodipine, 10 mg once daily, and salbutamol and ?uticasone inhalers. On examination, the patient had a Glasgow Coma Score of 15, she was apyrexial, her pulse rate was regular, at 80 per min, and her blood pressure was 176/99 mm Hg. There was no cardiac murmur or carotid bruits. She had left-sided weakness. What Investigation Is Indicated at This Stage? DOI: 10.1371/journal.pmed.0020079.g001 Brain imaging is necessary for two main reasons. The ?rst is to exclude a brain haemorrhage (responsible for 25% of all strokes [1]); against this diagnosis was the absence of headache and a normal Glasgow Coma Score. The second is to rule out a brain tumour. Computed tomography (CT) brain scanning on admission showed two areas of low density within the right cerebral hemisphere, one in the right parietal lobe and one in the posterior right frontal lobe (Figure 1), most likely ischaemic in nature. Small low-density lesions consistent with lacunar infarcts were also seen in both basal ganglia, the most prominent ones seen within the left basal ganglia. There was also marked frontal atrophy, and atrophy of the brain stem structures. The CT scan showed no evidence of haemorrhagic transformation of the infarct, a condition that is a contraindication for anticoagulation. Figure 1. CT Brain Scan on Admission Showing an Infarct in