A 75-Year-Old Man With Left-Sided Facial Droop: Osmosis USMLE Study Question

December 11, 2020

In a classic presentation of a thrombotic stroke, a patient awakens from sleep with neurologic deficits. Although uncontrolled hypertension is the most common cause of a hemorrhagic stroke, an ischemic stroke may convert to a hemorrhagic stroke. A hemorrhagic stroke presents with headache, vomiting, altered level of consciousness, and signs of increased intracranial pressure (ICP). In a patient who displays an altered mental status and respiratory drive, airway, breathing, and circulation with airway management takes precedence and intubation is frequently required.

A head CT scan without contrast is ordered as the first imaging study to differentiate an ischemic stroke from a hemorrhagic stroke. Ischemic strokes appear as dark areas on the CT scan whereas hemorrhagic strokes appear white.

Major Takeaway: An ischemic stroke may convert to a hemorrhagic stroke. Any patient with a mental status change and an altered respiratory drive with poor gag reflex requires evaluation of airway, breathing, and circulation with appropriate airway management.

Read more on ischemic stroke.

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