RT Book, Section
A1 Yazbeck, Moussa F.
A1 Rincon, Fred
A1 Mayer, Stephan A.
A2 Lee, Kiwon
SR Print(0)
ID 1101642372
T1 Intracerebral Hemorrhage
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101642372
RD 2024/04/23
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  (HCTZ)  25  mg  every  morning  for  hypertension,  metoprolol-XL  25  mg/day,  and  warfarin  5  mg/day.  His  wife  promptly  called  911  and  the  emergency  medical  services  (EMS)  arrived  on  the  scene.  The  time  of  onset  of  symptoms  was  established  to  be  approximately  20  minutes  ago.  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  applied  through  a  nasal  cannula  and  intravenous  access  was  secured.  The  EMS  personnel  suspected  a  stroke  and  they  notified  the  destination  hospital.On  arrival  at  the  emergency  department,  the  patient  was  found  to  be  more  somnolent  (GCS  is  8)  and  responsive  to  painful  stimulus.  Vital  signs  are  BP:  220/120  mm  Hg,  HR:  120  to  130  bpm,  RR:  24,  blood  sugar  by  fingerstick:  182  mg/dL,  and  cardiac  monitor  shows  a  rapid  AF.  Initial  computed  tomographic  (CT)  scan  showed  a  left  frontoparietal  intracerebral  hemorrhage  (ICH)  (Figure  2-1)  and  the  International  Normalized  Ratio  (INR)  was  5.8.