James
69, Male

The diagnosis was confirmed as a left middle cerebral artery territory stroke. The patient was admitted to the A&E department by London Ambulance Service within 2 hours of the onset of symptoms. He was assessed by the lead specialist nurse for stroke who was on-call for thrombolysis. She found that the patient had a moderate right hemiplegia and expressive dysphasia. There were no contra-indications to thrombolysis (see below) and he was therefore taken for an immediate CT scan of the brain. There was no evidence of haemorrhage and he was given the bolus of tissue plasminogen activator (tPA) after informed consent was obtained (his dysphasia was expressive rather than receptive). His platelet count, glucose and BP were within range that allowed thrombolysis to take place.

He was admitted to the acute stroke unit (ASU) where the remainder of the tPA was given. He made a good early recovery but required 4 weeks on the acute stroke unit (ASU) working with the multidisciplinary team including physiotherapy, occupational therapy and, most importantly, the speech and language therapists.

Whilst in hospital, his BP control was improved with the addition of an ACE inhibitor which was added to the 2.5mg of indapamide that he was on. He was prescribed perindopril. Aspirin was commenced at 300mg daily for 2 weeks post-stroke, then to be substituted for long-term clopidogrel 75mg thereafter. A lipid lowering drug (a statin) was added according to the RCP guidelines. His serum cholesterol was 6.5 mmol/L. Simvastatin was used at a dose of 40mg.

Although he was able to manage stairs on discharge, adaptations had to be made at home with stair rails. He is to be followed up in the nurse lead follow-up clinic at 3 months where his risk factor modification will be monitored.