Emergency Department Minute Quiz: Stroke Code

March 11, 2021
Brady Pregerson, MD

Our latest case report from Brady Pregerson, MD, features a woman in her 70s presenting with a facial droop and slurred speech. Can you help determine the correct diagnosis?

Patient History:

A woman in her late 70’s is brought to the ER by medics for facial droop, slurred speech, and left-sided weakness. She lives at a nursing home and at baseline is bedridden but A+Ox4 and able to feed herself. She was last seen normal about 1.5 hours prior to ER arrival. Her PMH includes CVA, HTN, DM, CAD, CHF, Afib, and GERD. She is hard to understand due to her slurring but does complain of headache and left-sided weakness. She verbalizes no other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for BP 171/89. Physical exam is notable for weakness in all extremities but she is able to lift her right arm and leg off the bed but not the left side, though she can move it a little. Speech is slurred to the point of being difficult to understand with left facial droop. Heart is regular and lungs are clear. Her skin is dry. A stroke code order set is entered.

What is the most important question to ask the medics?