Clinical Cases

Abstract

Presentation of the case of a 62-year-old male. Medical history: hypertension, dyslipidaemia and smoking. He was being treated with aspirin, angiotensin-converting enzyme (ACE) inhibitor and statin. The patient presented to the emergency department of a high-complexity hospital (Hub) with global aphasia and mild paresis of the right-side limbs. These symptoms appeared after a long car voyage and during physical exertion. The neurological disorders started at 20.45; the call to the emergency services was made at 20.50. The prehospital transportation was assigned the maximum severity code, called the “stroke code”, which means that the receiving hospital is put on pre-alert. The patient arrived at the emergency department at 21.25, and the neurologist was already present to receive him. At admission, the patient was alert and collaborating; global aphasia could be observed, along with eye deviation to the left, and central deficit of the VII cranial nerve. NIHSS = 9/42: 0-2-1-0-0-1-(0-0-0-0)-0-0-3-2-0. A blood sample was taken for urgent tests and a 12-lead ECG was carried out. Blood pressure was 130/80; heart rate was 70 and rhythmic, and oxygen saturation 97 % in ambient air. At 21.45, the patient was given a brain CT scan without contrast and a CT angiography with triphasic technique in order to study the collateral circulations.

In this chapter, a series of clinical cases explanatory of the various conditions relating to the pathology are collected and presented.