History of Present Illness:
A woman in her late 50’s with a history of ESRD and CAD on Plavix presents to the ED with 1 hour of global HA, vomiting and weakness in the left leg >arm
Vital Signs & Physical Exam:
Strength on left side are and leg was 4/5. Right sided strength was normal. No facial weakness
Initial Diagnostic Testing:
- Imaging: see below
What is the treatment for this?
- A) TPA
- B) Platelets and keep SBP <140
- C) Dialysis and keep SBP <160
- D) DDAVP and surgery
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What is the treatment for this?
- A) TPA
- B) Platelets and keep SBP <140 – CORRECT – This was recommendation from neurosurgery
- C) Dialysis and keep SBP <160 – Nephrology recommended against emergent dialysis due to bleed
- D) DDAVP and surgery
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CASE CONCLUSION: Neurosurgery contacted who recommended keeping SBP <140 and giving platelets to reverse Plavix. Admitted to ICU. Bleed did not progress.