Acebecker Posted May 26, 2012 Share Posted May 26, 2012 83 y.o. Female who is 5 mos s/p R ACA stroke. Has recovered nicely, but now c/o 2 day Hx of "black clouds" floating in L eye obscuring her vision. This will occur and last several hours and has recurred by her report x2, generally when she gets up at night. She has unknown cholesterols, known HTN that has never been well controlled on several meds and about 3 wks ago stopped taking her CCB; only on HCTZ and Aliskiren, BP still in the 180 systolic range. Nonsmoker. My opinion is that this lady needs emergent/urgent evaluation and that her busy life should take a backseat for a few hours while she gets sorted out. Am I wrong? Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 27, 2012 Moderator Share Posted May 27, 2012 Stat MRI brain is needed but not aggresive bp control on the watershed theory if neg mr would get bp under control asap and either way have a long discusion on code status and living will Link to comment Share on other sites More sharing options...
Guest JMPA Posted May 27, 2012 Share Posted May 27, 2012 I agree with a brain scan, she most certainly needs carotid dopplers for possible stenosis and EKG/pulse check to r/o A-fib. Link to comment Share on other sites More sharing options...
Acebecker Posted May 27, 2012 Author Share Posted May 27, 2012 Ok - thanks. This is actually a personal case. A family member is refusing reasonable care despite calling me and asking what she should do. It's been frustrating and I just needed to vent and validate for a moment. Link to comment Share on other sites More sharing options...
marilynpac Posted May 27, 2012 Share Posted May 27, 2012 Ok - thanks. This is actually a personal case. A family member is refusing reasonable care despite calling me and asking what she should do. It's been frustrating and I just needed to vent and validate for a moment. Sounds like grandma......just saying... Link to comment Share on other sites More sharing options...
KMD16 Posted May 27, 2012 Share Posted May 27, 2012 + an echocardiogram. Link to comment Share on other sites More sharing options...
polarbebe Posted May 27, 2012 Share Posted May 27, 2012 As mentioned above would also strongly consider MRA head and neck (can be done with or without contrast) or CTA head and neck (would no longer need carotids if neck is done). As an embolus phenomenon to the same vascular territory would be unlikely; an intracranial stenosis is more likely causing the repeat neurological symptoms when her BP drops (ischemia). As you mentioned this occurs when she gets up at night (BP drops). Some neurologists would also consider IV heparin or other AC until vessel imaging was done. Two years as a stroke PA. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 28, 2012 Moderator Share Posted May 28, 2012 if all else fails call 911 right after you step in the door of her house - then let her/him sign off on the do not transport Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.