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Old 08-01-2012
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Neuro Congenital Heart Disease and Stroke!

A 32-year old male is seen in the ED with sudden onset weakness of right upper and lower extremities developing about an hour ago. He has a H/O congenital heart disease since birth and remained asymptomatic up to now. For the past few days, he has been complaining of left lower extremity pain, tenderness and swelling. His vitals are HR-87 beats/min, RR-25 beats/min, temp-98.6 F. While you see him, you notice he is unable to speak. Based upon the scenario, What is the appropriate next step of management ??

A. Give a tablet of Aspirin immediately.
B. Begin intravenous fluids and wait until he speaks.
C. Order echocardiography.
D. Send him for doppler ultrasound and wait for results.
E. Get a non-contrast CT scan immediately.
F. Begin thrombolytic therapy immediately.
G. Begin i.v heparin and then place the patient on warfarin.

plzz explain in detail if possible ......
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Old 08-01-2012
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Paradoxical embolism go for thrombolytic therapy. i dont think there is a need fir Ct given the history.
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Originally Posted by sonu.agarwall View Post
Paradoxical embolism go for thrombolytic therapy.i dont think there is a need fir Ct given the history.
sudden onset weakness is hemorrhagic stroke i think ...bcoz ischemic stroke takes time to evolve ?????

I thought CT scan so as to differentiate b/w ischemic and hemorrhagic stroke......actually i dont have the answer for it..so need a good explanation for this........
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Embolic stroke is also sudden onset. Given history of dvt with congenital heart disease ie asd probably or even vsd, embolus to brain
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I am not sure if ct would still be necessary. Lets see others opinion
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Old 08-01-2012
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Onset of focal neurologic symptoms be it stroke or meiningitis or SAH...first line doesnt change...go for CT without contrast....then u can start therapy ...
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next step in stroke is non contrast ct..isnt
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yes, order for CT scan first to rule out hemorrhage and then manage the patient based on ct finding.
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So I assume the correct answer is Get a non-contrast CT scan immediately.......
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