A 67 years old female patient. She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT of her head and neck. Diabetes mellitus Type 2: Management: metformin 1000mg, daily enalapril 10 mg daily rosuvastatin 10mg, daily Atrial fibrillation (AF) Management: apixaban 2.5 mg, BD sotalol 40 mg, BD Cigarette smoking: 20 - 30 cigarettes/day, quit 5 years ago. She underwent a CT scan of the head and neck, but the results were normal. the patient was assessed as requiring changes to her hypertension & AF management and the following changes made: enalapril ceased the following medications commenced or changed; irbesartan/ hydrochlorothiazide 300/25, daily amlodipine 5mg, daily apixaban 5mg, BD This morning patient woke up at 0600 hours with a 5/10 headache. At 0700 hours she began to feel weak in her limbs, and her headache increased to 7/10. One side of her face began to "feel strange". She was able to call her neighbour, who brought her to the hospital. With all the symptoms and assessment, she is suspected of stroke and stroke team is reviewing her at the moment. Question: A week ago, the patient complained of headaches and dizziness. However, by the time the CT brain scan was undertaken, no abnormalities were identified. Consider all potential risk factors for this patient and then, with reference to relevant anatomical structures, describe pathophysiological mechanisms for this earlier presentation.
A 67 years old female patient.
She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT of her head and neck.
Diabetes mellitus Type 2:
Management:
- metformin 1000mg, daily
- enalapril 10 mg daily
- rosuvastatin 10mg, daily
Atrial fibrillation (AF)
Management:
- apixaban 2.5 mg, BD
- sotalol 40 mg, BD
Cigarette smoking: 20 - 30 cigarettes/day, quit 5 years ago.
She underwent a CT scan of the head and neck, but the results were normal.
the patient was assessed as requiring changes to her hypertension & AF management and the following changes made:
- enalapril ceased
the following medications commenced or changed;
- irbesartan/ hydrochlorothiazide 300/25, daily
- amlodipine 5mg, daily
- apixaban 5mg, BD
This morning patient woke up at 0600 hours with a 5/10 headache. At 0700 hours she began to feel weak in her limbs, and her headache increased to 7/10. One side of her face began to "feel strange". She was able to call her neighbour, who brought her to the hospital. With all the symptoms and assessment, she is suspected of stroke and stroke team is reviewing her at the moment.
Question: A week ago, the patient complained of headaches and dizziness. However, by the time the CT brain scan was undertaken, no abnormalities were identified.
Consider all potential risk factors for this patient and then, with reference to relevant anatomical structures, describe pathophysiological mechanisms for this earlier presentation.
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