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A case of 83 years old woman has been presented by Buck & Saver (2007). The woman had a history of hypertension, dyslipidemia, and long-term hypothyroidism. She also faced curative mastectomy for breast cancer. Findings showed that the stroke was probably caused by an artery-to-artery embolus caused by aortic arch atherosclerosis. At the time of stroke, she slumped to the right side, and her speech became nonfluent and slurred. However, language function slowly improved over the next 48 hours (Buck & Saver, 2007).
The woman was already receiving a statin and two antihypertensive medications (Buck & Saver, 2007). It has been noted that speed of treatment is an important factor in getting out of the problem (Musuka, Wilton, Traboulsi, & Hill, 2015). After taking the history of the patient and obtaining consent, the Field Administration of Stroke Therapy (FAST) –Magnesium (MAG) phase 3 neuroprotective study was started at 33 minutes of stroke. The trial infusion consisted of 4 gm MgSO4 administered intravenously over 15 minutes followed by a maintenance infusion of 16 gm MgSO4 over 24 hours. One of the most useful therapeutic strategies in acute ischemic stroke is reperfusion of the ischemic brain in the early stages to deal with ischemic penumbral tissue. Moreover, reduction of final infarct size and improvement of functional outcomes are also important to deal with the problem. Therefore, after diagnosis of the acute ischemic stroke, the woman was treated with widely available reperfusion treatment, i.e. intravenous tissue plasminogen activator (tPA) about 2 hours after the onset of symptoms. After 24 hours of stroke, the woman was started on 81 mg aspirin daily. For 10 days, the woman was transferred to an inpatient rehabilitation unit (Buck & Saver, 2007).
Even after discharge, it is important to take care of the woman. Some supportive services and skilled nursing care could be of sufficient help. Moreover, palliative care consultation is important for the woman (Buttaro, 2013).
References
Buck, B. H., & Saver, J. L. (2007). A case of acute ischemic stroke: optimizing management with penumbra and vessel imaging. Nature Clinical Practice Neurology, 3(8), 465-469.
Buttaro, T. M. (2013). Primary Care: A Collaborative Practice: Elsevier/Mosby.
Musuka, T. D., Wilton, S. B., Traboulsi, M., & Hill, M. D. (2015). Diagnosis and management of acute ischemic stroke: speed is critical CMAJ September 8, 2015 187: 887-893; published ahead of print August 4, 2015, doi: 10.1503/cmaj. 140355.
