Stroke: Is it sometimes overlooked?

Abstract

Introduction Acute stroke is defined as an abrupt focal or global disorder of cerebral function. Ischemic stroke is significantly more frequent than the hemorrhagic stroke (75-80% of all). Occlusion of a blood vessel by thrombus or embolus causes it and it is characterized by sudden onset and rapid development of neurological symptoms. Object The aim of this paper is to point out that in cases when patients present with acute mental disorder and no apparent neurological symptoms, stroke should be considered as a possible diagnosis. Materials and methodology The data from the medical report and from the discharge list have been used to present this case of a patient with ischemic stroke. Results This is a case report of a 66-year-old male patient who suddenly developed a kind of a conduct disorder and psychomotor agitation, followed by confusion and occasional aggression. The EMS team found the patient in the bathroom of his home, switching on and off the washing machine. His wife said that he woke up 3 hours ago and began to behave strangely (urinated all over the house). Known facts about his previous condition were the following: smoker, with no history of alcohol abuse, had high blood pressure, but didn't take any medications. Verbal communication existed, though confused and anxious, patient spoke fluently with occasional meaningless words. He could move and execute certain simple tasks, but he had no insight into his condition; he refused help, resisted examination as well as going to the hospital. For the benefit of the patient, a police patrol was invited to escort him to the health facility. A partial examination was conducted: BP = 240/120 mmHg and blood glucose = 7 mmol/l; more detailed examination was not possible due to patient's reluctance for cooperation. Considering that problems occurred suddenly, and the possibility of intoxication was rejected, the patient was transported to a neurologist with a diagnosis of a possible stroke, which was eventually confirmed after neuroradiology diagnostics. Discussion The diagnosis of acute ischemic stroke should be confirmed during the first 3 hours to a maximum of 4.5 hours from the first symptoms, if thrombolytic therapy is to be included. We would have made a serious mistake and would have wasted precious time, if we had assumed that a mental disorder is the right diagnosis. Conclusion When examining a patient with acute mental disorder it is necessary to consider the possibility of the underlying organic cause, and therefore rule out the potentially life threatening conditions such as hypoglycemia, cerebral stroke, subdural hematoma, meningoencephalitis, etc.