HuBio 564: Principles of Pharmacology II
Case Study 7
You are performing a routine physical examination on a 63-year-old man. He tells you that a couple of months ago he experienced a few days worth of right sided numbness and word finding problems; his symptoms resolved spontaneously and his neurological examination is now normal. His past medical history is notable for the fact that he rarely visits doctors and smokes 1 pack of cigarettes per day. He is taking no medications.
He is overweight, and his blood pressure is 145/90. You order blood work and an MRI; the MRI shows patchy infarction in the left hemisphere.
What is the diagnosis?
What should be done next?
Work up shows evidence of diffuse atherosclerosis in the intracranial and extracranial arteries. The degree of stenosis of the left extracranial internal carotid artery is approximately 50%; the degree of stenosis of the proximal left middle cerebral artery is about 70%. His cardiac ejection fraction is 45% and his cardiac rhythm is normal sinus.
What is the most appropriate anti-thrombotic drug on which to start the patient?
The blood work returns. His fasting lipid panel reveals a total cholesterol of 205, triglycerides of 275, an LDL of 135, and an HDL of 34. His glucose is 145 and you order a hemoglobin A1c - it is 6.9%. His renal function is mildly abnormal with a creatinine of 1.2.
What further diagnoses do you make?
Based on these diagnoses, other therapies do you recommend for stroke prevention?
What lifestyle changes do you recommend?
He ignores all of your advice - he continues to smoke and decides to take none of the medications you prescribe. Six months later he presents to the ER with a dense right hemiparesis and aphasia; his symptoms started 45 minutes prior to his arrival.
What medical therapies are available to him?
His blood pressure is 195/115; are you able to treat him with tPA?
Use the Submit Case Report button or go to http://depts.washington.edu/phcol/case_sub.html to submit this case.
Please check the status of your work through the My Grade link on the SOMOC page.
