NCCEd: Neurocritical Care Education for Residents

A 41 year-old woman with a history of gestational diabetes presents from home with an acute onset of dysarthria and right hemiplegia. Last known normal was 5 hours ago when her family ate breakfast with her. When her husband came home for lunch, he found her slumped over in her chair, unable to move her right arm and leg.

You examine the patient as they arrive in the ED with EMS. Initial vitals are notable for BP 120/65, HR 60, RR 16, SpO2 98% on room air. Point-of-care glucose is 115. She is somnolent, but briskly wakes up for a few minutes at a time with verbal stimulation. You help get the patient onto the scanner table, facilitating acquisition of a non-contrast head CT and CTA of her head and neck.

NCHCT

1/3

2/3

3/3

▲ ▼

You identify a large area of frank infarct within the left MCA territory, with no clear evidence of hemorrhage, as well as a cutoff of the proximal left M1 segment. At this point, you're able to reach the patient's husband, who confirms the HPI with her last known normal, her scant medical history, and lack of any prescribed medications.