Suddenly the Tea Cup Fell

Anastasia Peabody-Smith (57) had her girlfriends over for that regular 5 o'clock tea at her Woolloomooloo mansion when she suddenly suffered a stroke. Her friends called the ambulance at once and so she reached the emergency unit only half an hour after the incident. The neurologist in the emergency room diagnosed a hemiparesis on the left and transferred her immediately for a cranial CT to verify and further specify the stroke. Giufeng happens to be on duty and is the first to see the CT images flip onto the monitor (Fig. 11.6). She knows that everything depends on rapid management in these cases. Thrombolytic treatment has the potential for fast resolution of the underlying clot obstructing a brain vessel. This is hopefully followed by resolution of the symptoms. Therapy is best initiated in less than 3 hours (and in some cases up to 6 hours) after onset of symptoms but can only be performed if there is no associated intracranial hemorrhage.

Noncontrast Hemorrhage Stroke

Fig. 11.6 Depicted you see the relevant CT image of Mrs. Peabody-Smith. Can you already make the diagnosis?

• Are the basal ganglia and the white matter of normal density?

• Are the sulci narrowed? Are the gyri thickened?

• Do the vessels appear dense on noncontrast CT?

• Is there evidence for hemorrhage?

• If so, does the hemorrhage cause any displacement?

Fig. 11.6 Depicted you see the relevant CT image of Mrs. Peabody-Smith. Can you already make the diagnosis?

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