George is a 59-year-old lawyer who presents to the emergency room with weakness and numbness of his right side that began while playing golf this morning. George says he had an unusual headache when he first woke up, but he was looking forward to golfing and the headache was not bad enough to prevent him from golfing. While on the golf course, George suddenly had an episode of weakness. After this weakness, George realized he could not move his right side, could not speak, fell off his seat in the golf cart, and could not get up. George’s friends called 911 to bring him to the emergency room. This episode with neurological deficits has lasted longer than 1 hour and persists while the patient is in the emergency room. George has a history of hypertension, diabetes mellitus type 2, and 30-pack-years of smoking.
What should the initial history and physical examination include?
What are the differential diagnoses for this patient?
What is the most likely diagnosis for this patient? Explain your answer.
What treatments will be used for the initial management of the patient’s condition?
What factors are contraindications for thrombolytic therapy?
What are the goals of stroke management?