Stroke

Patient Profile

B. W. is a 72-year-old white female admitted 2 days ago to the medical unit with a stroke. She has left-sided hemiparesis. A noncontrast CT scan, about 2 hours after the onset of symptoms, was negative. A second CT scan, 12 hours later, was positive for an ischemic area in the right hemisphere.

Objective Data

Physical Examination

Pupils equal, round, reactive to light and accommodation

Decreased sensation in left lower extremity, no sensation in left upper extremity, normal sensation to right upper and lower extremity

0/5 strength left upper extremity, 1+/5 left lower extremity, 5/5 right upper and lower extremity

Left facial droop

Slurred speech

Diagnostic Studies

A barium swallow study has been ordered for 1:00 PM

Subjective Data

Daughter is at the bedside, she is upset and tearful, stating "Mom doesn’t know where she is and she keeps waving her arm at me and getting upset, trying to tell me something, and I don’t know what she is trying to tell me."

Discussion Questions

Why was the first CT scan negative? What implication did this have on B. W.’s care?