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Symptoms Manifestation
A young male student showed symptoms similar to a stroke. First complaints included being unable to move one side of the face. Further examination demonstrated that the patient was unable to wrinkle one side of his forehead, show his teeth and pucker his lips on the same side. The patient also complained about the changes in the taste sensation and “dry mouth” sensation. Left eye tear secretion proved to be below normal. A week before the sudden incident, the patient suffered from influenza-like symptoms.
While studying this case, a physician would firstly have to pay attention to the previous symptoms. Since the patient reported manifestation of influenza-like symptoms, the recommended course of action would be to draw connections between these symptoms and possible complications of influenza. Such complications may include – among others – congestive heart failure and heart attacks (DerSarkissian). However, these complications do not directly result from influenza; they are mostly complicated by prolonged influenza. Therefore, there is a possibility that the patient has been suffering from heart diseases for some time.
Still, the only apparent stroke symptom that the patient experienced is face drooping. Other symptoms that are present are gait disturbances, coordination or balance loss, troubled vision, dizziness, severe headache, confusion, troubled speech, memory loss, troubled swallowing, involuntary eyes movement (Stöppler). Therefore, it is possible that other diagnoses could fit the description. It may also be some disease that did not manifest itself earlier. Thus, it would be advisable to examine the present symptoms further to grasp the full understanding of what may cause them.
However, all of the symptoms combined may as well be a result of a stroke. Dry mouth sensation (or xerostomia) may be caused by stroke or Alzheimer’s disease (Nordqvist). Facial weakness is also included in the list of the most possible symptoms of strokes.
Diagnosis
Taking every symptom into account, the therapist may be able to reach certain diagnoses. It is possible that the patient is suffering from cerebral infarction (ICD-10 – I63.9) or Bell’s palsy (ICD -10 351.0). However, Bell’s palsy may only refer to some of the symptoms from which the patient is suffering. Cerebral infarction, on the other hand, covers all of them. Assuming that the taste sensation changes and xerostomia are most likely a result of facial paralysis, the physician will probably come to a conclusion that the patient had a stroke.
Other possible diagnoses may include acute embolism and thrombosis of an unspecified vein (ICD-10 – I82.90). More specifically, this may be arterial thrombosis since it is considered to be one of the leading causes of ischemic strokes.
Condition Treatment
Since the definite diagnosis is difficult to determine without further thorough examination, it is advisable to treat the patient with accordance to guidelines provided for treatment of ischemic strokes and arterial embolism. There are different approaches to treating both. The procedures include chemical treatment and surgical intervention. Since the symptoms in this case are mostly not severe, it is possible that treating the patient with chemicals would be sufficient. However, if the patient’s condition begins to rapidly or gradually worsen, the treatment must move to surgical interventions.
According to Powers et al., “Rapid administration of intravenous recombinant tissue-type plasminogen activator (r-tPA) to appropriate patients remains the mainstay of early treatment of acute ischemic stroke” (6). Therefore, this is the first guideline to apply in this case. Restoring the blood flow in ischemic stroke patients is important. This will be the most important step to assure that the patient will not suffer any further damage to brain functions which will significantly improve chances of recovery and reduce chances of death. If the patient in this case meets all of the national and international eligibility guidelines, administration will most likely improve functional outcomes in three to six months if r-tPA treatment is applied in four to five hours since the symptoms have been detected.
Other guidelines suggest that the physician must initiate the BP therapy (Kernan et al., 2170). This is a notable recommendation since there is no evidence that the patient had suffered another stroke in the past. However, this procedure would be only possible to initiate if the patient demonstrates a stable blood pressure of ≥140 mmHg systolic or ≥90 mmHg diastolic. If the patient did suffer another stroke in the past – which would mean that this is a case of recurrent stroke – it is recommended to resume the BP therapy. This would be advisable to both prevent the recurrent ischemic stroke and other vascular events connected to it.
Another crucial component needed to successfully conclude comprehensive antihypertensive therapy would be to adjust the patient’s lifestyle after the treatment is successfully carried out. This would include advising the patient to quit all of his health-threatening habits (i. g. smoking, alcohol consumption, etc.), start managing stressful activities, and improve the overall physical condition. Another advisable course of action would be to sign up for an appointment with a nutritionist to plan a more healthy diet.
In case the patient is suffering from arterial embolism, the recommended treatment would include controlling the symptoms and restoring the blood flow in the affected area of the body. It is also important to determine what caused the formation of blood clot. If the cause is not found, further complications may follow which will eliminate the progress to achieve recovery (“Arterial Embolism”).
However, the treatment must begin independently of determining the conditions that caused the formation of blood clot. The medicines that the patient must be treated with include warfarin or heparin (anticoagulants) and antiplatelet medications (aspirin or clopidogrel). They would be used to prevent further clot formations. To relieve the patient from any possible discomfort or pain, painkillers must be given through a vein. The primary goal, of course, is to help the clots dissolve. To achieve that certain thrombolytics will be applied. One of such medicines is streptokinase.
Due to the variety of types of conditions and dysfunctions that may cause arterial embolisms, the medicine treatment may not be sufficient. Therefore, the patient may require surgery. Different procedures are used to treat such condition. Firstly, surgeons may attempt to bypass the artery that is affected to form a new source of blood supply (arterial bypass). Secondly, the clot may be directly removed from the artery via balloon catheter that is placed into the artery; in case the surgeon cannot access the affected artery, they will perform an open surgery on this artery (embolectomy). Finally, the procedure of angioplasty may be applied. The surgeons will open the artery with a balloon catheter. In this procedure, a stent may or may not be used.
Works Cited
“Arterial Embolism.” MedlinePlus, 2016.
DerSarkissian, Carol. “What Are Flu Complications?.” WebMD, Web.
Kernan, Walter et al. “Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack.” Stroke, vol. 45, no. 5, 2014, pp. 2160-2238.
Nordqvist, Christian. “Dry Mouth (Xerostomia): Causes, Diagnosis, and Treatment.” Medical News Today, Web.
Powers, William et al. “2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment.” Stroke, vol. 46, no. 6, 2015, pp. 1-47.
Stöppler, Melissa. “14 Warning Signs and Symptoms of Stroke.” MediciNet, Web.
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