A wake-up ischemic stroke presenting as left hemiplegia on a ‘T’ carotid occlusion with secondary clinical worsening and Perfusion CT demonstrated perfusional mismatch. Decision Making


Inselspital – University of Bern
Department of Diagnostic and Interventional Neuroradiology, Bern, Switzerland

Does your patient have to prove they’ll have a favorable outcome before you treat them? Should age or comorbidities play a role in your decision to treat? How should overall cost-effectiveness be considered in terms of treatment options – and outcome? These are just a few of the fundamental questions our panel debates in this passionate and no-holds barred discussion from a 2015 SLICE case presentation.
Join Jan Gralla of Inselspital, the Department of Diagnostic and Interventional Neuroradiology at the University of Bern in Bern, Switzerland as he unfolds how his team chose to treat their patient – an 87-years-old female in decent health, living a “normal” life with her husband, who shows signs of a stroke the morning that this case unfolds. Presenting with an NIH Stroke Scale of less than 18, she rapidly deteriorates before imaging has been completed – how to proceed? There’s an excellent time window, though intubation became necessary due to clinical worsening – can intubating your elderly patient negatively affect outcome? How do you approach general anesthesia? And what about blood pressure?
In the SLICE tradition this is no one way street, but a challenging discussion between speaker, expert panel and audience. The ensuing conversation touches such points as the role of imaging and the debate concerning our current use of perfusion maps. On the moral side, the question arises of when – and why – we choose to proceed. Can this elderly patient – if treated – make a sufficient level of functional recovery to warrant treatment? What would the patient and their family want?
Results? Follow this fascinating case and discussion now – and join the conversation today!