Clinical case · Stroke
Slurred speech and a clumsy right hand
An 81-year-old woman arrives five and a half hours after waking with slurred speech and a clumsy hand, and is found to be in atrial fibrillation. Manage the acute phase safely and plan secondary prevention.
Intermediate 15 minNeeds clinical review
You will learn to
- Decide eligibility for thrombolysis by time and imaging, not age
- Apply the acute basics: swallow screen, aspirin, blood pressure, oxygen and glucose targets, and avoiding harm
- Plan secondary prevention after cardioembolic stroke, including the timing of anticoagulation, and rehabilitation
Presentation
Step 1 of 10An 81-year-old woman is brought to the emergency department at 12:30. She went to bed well at 22:00 and was last seen normal by her husband at 07:00, when she got up to make tea. At 08:00 he noticed her speech was slurred and she could not hold her cup properly in her right hand.
They waited, hoping it would pass, then called their son, who drove them in.
References
- Liu L, Li Z, Zhou H, et al. Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update. Stroke Vasc Neurol. 2023;8(6):e3. doi:10.1136/svn-2023-002998 · PubMed 38158224
Last updated 2026-10-21.
Spotted an error or something out of date?Report a problem with this page