Amelia Frankish is 67 years old. She

Amelia Frankish is 67 years old. She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT (computerised tomography) of Amelia’s head and neck. Vital signs:â RR: 18 bpm SpO2: 98% BP: 180/92 mmHgâ (MAP 121 mmHg) HR: 98 bpm Temp: 37oC Pain assessment:â Provoking/palliating: pain is worse when Amelia moves her head suddenly, nothing seems to relieve the pain Quality: the pain feels like extreme pressure on theâleftâside of her head Region/radiation: the pain is confined to her head Severity: 9/10 Timing:âfirstâpain onsetâwas about 2 hours ago Neurological assessment:â GCS: 15 Pupils: PERRLA ROSIER (Recognition of stroke in the emergency room) Scale Loss of consciousness or syncope: NO Seizure activity: NO Asymmetric facial weakness: YES Asymmetric arm weakness: YES (rightâupper limb paralysisâ-âunable to respond to movement request) Asymmetric leg weakness: YES (rightâlower limbâparesis – mild weakness) Speech disturbance: YES (some slurring of words (dysarthria) is noted) Visual field deficit: NO Other: Limb sensation:ârightâupper limbâanaesthesia;ârightâlower limbâ- paraesthesia (tingling feeling).â Amelia appears pale and anxious. She has not had her medications today. â Investigation data – performed AFTER triage Cardiovascular assessment An ElectroCardioGram (ECG) is undertaken which showsânormal sinus rhythm.ââââ Blood tests are ordered including full blood count (FBC), urea & electrolytes (U&Es), liver function tests (LFTs), coagulationâstudies (COAGs) including Anti-Xa levels. Metabolic assessment Blood Glucose Level (BGL): peripheral 9.8 mmol/L (Amelia reports not having eaten since yesterday, nor has she had her medications today)â Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain Performed Date: 25/3/Year Time: 0830 Final Report CT BRAIN CLINICAL NOTES: Patient presents with severe headache, dysarthria, limb anaesthesia, paresis, and paralysis. CT 7 days ago – no adverse findings Findings: A non- contrast CT has been acquired. Nil intracranial haemorrhage noted. Complete occlusion of the left middle cerebral artery noted. IMPRESSION: Middle cerebral artery thrombosis (not conclusive “1/24 (hourly) neurological assessment for 4 hours” has been requested for Amelia. Referring only to the limb movement component of the assessment, provide a rationale for this intervention by: referring to relevant anatomical structures and discussing the pathophysiological mechanisms of deterioration that would cause observed changes to Amelia’s limb movement assessment, identifying TWO other assessment data (signs or symptoms) that might be evidence of neurological deterioration, and identifying the guidelines that support this intervention of hourly neurological assessment.

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