Illustration by Jan Schwochow
Steve Gschmeissner/Photo Researchers
Doctors initially suspected a blood clot which can cause a stroke.
CNRI/Photo Researchers
An aortic dissection.
Posted on 02/23/2008 10:53:58 PM PST by neverdem
Diagnosis
1. Symptoms
The lights at the Metropolitan Opera House were already beginning to dim as the elderly couple made their way past the pumps and wingtips of the mostly seated audience. As the familiar notes of “La Traviata” began to sound from the orchestra, the man leaned over to his wife of 60-some years. “I feel terrible,” he whispered. He struggled to his feet, and the two edged back down the row.
The man leaned heavily on his wife. His right leg was too weak to support him. In the lobby, he gratefully lowered himself into a wheelchair. He felt awful and wondered if he might be dying. Finally, he heard a siren announcing that an ambulance was on its way.
In the emergency room at Roosevelt Hospital, Dr. Barbara Kilian hurried to see the new arrival. He looked younger than 81, trim and, judging from the way he filled the stretcher, quite tall. His angular face was pale and covered with sweat. The young doctor glanced at the monitors. Heart rate was slow and steady; blood pressure was normal. The patient seemed comfortable. She had a little time.
He was a neurosurgeon, the patient told the doctor. He and his wife went to the opera to celebrate her 77th birthday. He felt fine all day until quite suddenly he did not. He was generally healthy despite a little high blood pressure and mild Parkinson’s disease. The terrible feeling he had in the theater was gone, but his right leg was numb, and he couldn’t move it. Could he be having a stroke? “I’m wondering that myself,” the doctor told him. “Then you should give me tPA,” he told her. TPA, short for tissue plasminogen activator, is a clot-busting medicine used to treat strokes and heart attacks...
(Excerpt) Read more at nytimes.com ...
Thought this one would interest you.
The first rule for weakness and unilateral leg numbness without other CVA symptoms is to rule out a AAA.
The guy was still enough within the tPA window to rule out a CVA, and a simple neurovascular assessment of the man would have the alarm bells ringing for a AAA.
I’m very glad that people like you and your colleagues know what to look for in these situations. There are so many ways a human body can malfunction.
The learning curve will always be steep. I just pray that my prior experience- and above all, the guidance of Almighty God- will help me to see a problem like this before it becomes lethal.
Most humbly yours,
Gunner
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