RT Book, Section A1 Rincon, Fred A1 Mayer, Stephan A. A2 Lee, Kiwon SR Print(0) ID 1151888704 T1 Intracerebral Hemorrhage T2 The NeuroICU Book, 2e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071841443 LK neurology.mhmedical.com/content.aspx?aid=1151888704 RD 2024/03/28 AB A 58-year-old African American man with a history of hypertension, mechanical mitral valve replacement, alcohol abuse, and atrial fibrillation (AF) suddenly developed nausea, vomiting, and left arm and leg weakness. He takes hydrochlorothiazide, 25 mg every morning for hypertension; metoprolol-XL, 25 mg/d; and warfarin, 5 mg/d. His wife promptly called 911, and the emergency medical services (EMS) arrived on the scene. The time of onset of symptoms was established as approximately 20 minutes before arrival. A quick Cincinnati Pre-hospital Stroke Scale assessment shows left-sided weakness including face, arm, and leg and a Glasgow Coma Scale (GCS) of 12. Oxygen was supplied through a nasal cannula, and intravenous access was secured. The EMS personnel suspected a stroke and notified the destination hospital.On arrival at the emergency department, the patient was found to be more somnolent (GCS, 8) and responsive to painful stimulus. Vital signs were as follows: blood pressure (BP), 220/120 mm Hg; heart rate, 120 to 130 bpm; respiration rate, 24; and blood glucose by fingerstick, 182 mg/dL, and a cardiac monitor showed a rapid AF. Initial computed tomographic (CT) scan showed a right fronto-parietal intracerebral hemorrhage (ICH) (Figure 2-1) and the International Normalized Ratio (INR) was 5.8.