Stroke Stan — Ischemic Stroke
Time is brain — last known well decides everything
Stan's left brain loses its blood supply mid-sentence. The right side of his face falls, his arm drifts down, and a clock nobody can pause starts running.
Stan's middle cerebral artery clots. Facial droop, arm drift, slurred speech, sudden onset. A non-contrast CT must rule out bleeding before thrombolytics, which are given within 3 to 4.5 hours of last known well. Then swallow screen before anything by mouth.
Read Stroke Stan's full story →The story arc
The setup
Untreated atrial fibrillation, no anticoagulant, blood pressure never controlled.
The turn
At breakfast his face droops on one side, his arm drifts when raised, and his speech turns to mush. His wife notes the time: 7:40.
The crisis
In the ED the decision hinges on one scan: is this a clot or a bleed?
The save
Alteplase within the window, then neuro checks, tight blood pressure limits, bleeding precautions and a swallow screen before his first sip.
NCLEX study section — Ischemic Stroke
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.