PT 8390 CM II - PBL Case - Mrs. Tannaz Kahlili
Part 1, Mrs. Tannaz Kahlili
A 76 y/o female brought to the ER by her daughter and her 73 y/o husband. Patient walked with the
substantial help of her daughter, and was unable to use her left arm. The only medication her family knew she
was taking was a “water pill”. Pt. confused, and oriented to person only. At admission, she showed evidence
of acute CVA. Her patellar deep tendon reflexes were 2+ on the right and 3+ on the left, with a positive
Babinski sign on the left. Vital signs: Heart rate: 72 Blood pressure: 188/102 Temperature: 98.2 degrees.
Weight 98 pounds, Height 5’. CT of head revealed MCA lesion and patient was placed on ASA 325 mg QD
and transferred to medical intensive care for observation. The following day, patient’s daughter brings a card
from her Mother’s purse with the information: Medtronic®: type: DDD, AICD.
Day 3: Evaluation performed in Hospital PT Dept.
Sensation and proprioception absent in L UE, diminished in L LE. Exhibits L sided neglect, UE > LE, and L
visual field deficit.
Unsupported sitting: leans to affected side.
Transfers bed to wheelchair, toilet with standby assistance as long as pt. instructed to “move over here” or
“sit here”. Pt. does not try to stand up straight during the transfer. Efforts to break up the skill into parts
seemed to confuse pt. Unable to carry out three part instructions.
Fatigues easily.
Bilateral LE edema, pitting to 3” above medial malleolus.
Day 4:
Blood pressure 164/94 sitting, 126/70 standing, HR 72, Resp
20
Weight shifting / gait training in parallel bars initiated: 6’ x 2,
requires Min Assist to advance L leg. Hyperextends or
buckles L knee c WB. After amb. patient states: “Yes … ah …
tired … er … wheel … yah”. Post activity: BP 182/88 sitting,
HR 96, Resp 32, RPE and Dyspnea estimation attempted but
therapist was unsure of patient’s full understanding of the
scales.
Day 5:
Mild spasticity developing in L UE distal to elbow.
Care Coordinator requests recommendation from PT for
placement after discharge from Acute Care, which is
anticipated to be on day 7.
Pathology: CVA. Given the case
information, explain what you think is the
etiology / pathogenesis of Mrs. Kahlili’s
CVA.
Resources:
 Bottomley: p.412-436 Stroke; p.553555 communication (tables); p.465466 pacemakers and ICD
 O’Sullivan C.17: Stoke (review); also
p.1005-1012 & p.1016 aphasia
 DeTurk: p.395-401 - Stroke and CVP; p.353-356 – pacemakers
 ACSM 7th ed. p.194-197 pacemakers
 A small library for the Center for
Interdisciplinary Geriatric
Assessment Program (CIGAP) is
located at the Adult Day Connection
in Clark Hall, open M-F 7:30-12:30
and 1:30-4:00. See website list.
Assign members so that each of the
databases below is covered. Findings will
be reported in a Table of Evidence, using
the Footnoting Protocols.
Open-access Databases:
1. “Stroke” full-text on-line journal
at:
http://stroke.ahajournals.org/
2. PEDro
3. PubMed
4. Hooked on Evidence
5. Cochrane Review Group: Stroke
Group