A. Neuro Case Study M.M is an 70 yo female with history of dementia

M.M is an 70 y/o female with history of dementia, HTN, high cholesterol, and TIA who presents to the ED with family at 13:30 with left facial droop and left sided arm and leg weakness. The son explains to the staff that his mother is currently being treated for a UTI and is more confused than usual when she has these infections but seemed different. The patient is usually fairly independent being able to feed and dress herself, cook her own food, and rarely using her cane to ambulate. "My mom is very independent....and sometimes stubborn. She likes to do things by herself and doesn't want me helping her. She takes her medicine when she feels like it", the son says. He also states that she has fallen a couple times at home because she refused to use her cane. Apparently around 12:30, his mother was eating lunch today when he heard her coughing rather incessantly. He came in to the room to check on her and noticed her face was droopy on one side, had slow, slurred speech and appeared to be leaning more towards her left side. Upon assessment, the patient is A&Ox1-2, person and occasionally place. Sometimes she says she is in the hospital and other times she is asking her son "Why are all these people in our house?" Vital signs are BP 207/109, HR 92, RR 20, T 98.2, O2sat 99%/RA. NIH on arrival was 7 per nursing. The patient is dysarthric and has a mild left facial droop. Patient does not follow commands consistently. Patient is able to move her left arm and leg spontaneously but is scored for left arm ataxia and generalized left sided weakness. CT head shows severe atrophy and small vessel disease. TPA is administered as patient is within the treatment window, no contraindications, and family is agreeable.