History of Present Illness: A man in his late 30’s with no PMH is brought to the ED by medics for sudden confusion and ataxia while driving. He had right facial droop and diplopia on exam. His head CT was negative and he was treated with TNK. About 20 minutes later the nurse calls you because he is short of breath. He seems to be struggling a bit and not handling secretions great. The tongue seems a bit enlarged so you treat for anaphylaxis, a known risk with TPA. Ten minutes later the nurse calls you back because he is unresponsive and gurgling. Pulse ox has dropped to the 40’s and heart rate as well. You are worried about a bleed. You intubate.
What should you do next?
- A) Cryoprecipitate and other meds to reverse TNK then repeat CT
- B) Repeat CT before other intervention
- C) Second dose of epinephrine
- D)
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ANSWER:
CASE CONCLUSION: repeat CT and CTA are unchanged with no bleed or progression of disease in the left vertebral artery. CT the next day shows a cerebellar stroke. MRI showed strokes in CBL, L thalamus, brainstem, L occipital lobe and the medulla