The patient presented to the emergency department at Norton Audubon Hospital. He had been found at home, down in the bathroom.
The patient presented to the emergency department at Norton Audubon Hospital. He had been found at home, down in the bathroom.
May 3, 2021
47-year-old male arrived at Norton Audubon Hospital, 12:27 a.m.
Vascular neurologist Mohammad S. Alsorogi, M.D.
Endovascular neurosurgeon Tom L. Yao, M.D.
Presenting complaint
The patient presented to the emergency department at Norton Audubon Hospital. He had been found at home, down in the bathroom. The initial call was for a patient having a seizure; upon arrival to the patient’s home, emergency medical services personnel found the patient with right-sided weakness and slurred speech.
EMS report
Louisville Metro Emergency Medical Services responded to the patient’s home where they found him lying in the hallway just outside of a bathroom. They immediately noticed the patient’s right-side weakness, and upon further evaluation found the patient had slurred speech. The crew obtained a detailed history of the patient and alerted the emergency department.
Outcome
This patient received alteplase in the emergency department 40 minutes after arrival. Dr. Alsorogi assessed the patient in the Norton Audubon Hospital emergency department via telemedicine. The patient was transferred to Norton Brownsboro Hospital 61 minutes after arrival for a mechanical thrombectomy.
Dr. Yao removed a sizeable clot from the patient’s left middle cerebral artery. The patient was discharged to acute rehab five days later. He was still experiencing expressive aphasia upon discharge. He hopes to return to marathon running in the future.
- CT Head: A hyperdense left middle cerebral artery is seen on an otherwise normal CT.
- CT Perfusion: Small area of infarcted tissue (purple) within the left basal ganglia and left temporal lobe. A large area of penumbra (green) is seen within the entire left hemisphere.
- Pre mechanical endovascular reperfusion (MER) angiogram: Reveals an abrupt cutoff of the left middle cerebral artery.
- Post-MER angiogram: Reveals a successful recanalization of the left middle cerebral artery
- Post-tPA/MER MRI: Diffusion restriction involving left basal ganglia, left parietal lobe; this corresponds to the CT perfusion. This means there was no further brain infarcted, and the at-risk brain was saved.
Norton Healthcare has the largest network of accredited stroke centers in the area and is one of the leading organizations of the Norton Healthcare/UK Healthcare Stroke Care Network that has affiliate hospital members across the region.
- Norton Brownsboro Hospital’s designation as a Comprehensive Stroke Center by DNV Healthcare represents the highest level of care.
- The Joint Commission certified Norton Audubon Hospital and Norton Hospital as Primary Stroke Centers and Norton Women’s & Children’s Hospital as an Acute Stroke Ready Hospital.
