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Suggest Treatment For Ischemic Stroke
Question: appx 4 weeks ago a had an ischemic stroke. during the hours of the first day while in the er and then soon after I was admitted as inpatient, I received first a ct scan, followed by an mri and a scan of the ceratoid arteries. Are you allowed and able to receive for review the radiology images I received at that time, and the reports that came with them for second opinion? Is there any follow up radiology or other similar things I should get after those initial scans, and if yes, at what time intervals, and which type. am I asking the correct type of specialist these questions?
Brief Answer:
You can upload your images and reports for evaluation
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Yes, you can upload images of mri as jpeg or pdf file for evaluation and second opinion.
In your case , other investigations for hypercoagulabilty may be required.
Polycythemia is also associated with hypercoagulabilty and risk of stroke.
Other causes of stroke to be evaluated like diabetes, hypertension, dyslipidemia, cardiac evaluation and carotid doppler.
You should continue anti platelet drugs.
Repeat imaging is usually not required until new symptoms or deterioration occurs.
Hope you found the answer helpful.
Do get back with further details.
Regards
Dr N Kumar
Neurologist
You can upload your images and reports for evaluation
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Yes, you can upload images of mri as jpeg or pdf file for evaluation and second opinion.
In your case , other investigations for hypercoagulabilty may be required.
Polycythemia is also associated with hypercoagulabilty and risk of stroke.
Other causes of stroke to be evaluated like diabetes, hypertension, dyslipidemia, cardiac evaluation and carotid doppler.
You should continue anti platelet drugs.
Repeat imaging is usually not required until new symptoms or deterioration occurs.
Hope you found the answer helpful.
Do get back with further details.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I am sorry to be delaying but have not quite figured out how to transfer records and stuff for your viewing. I am still working on it. can you tell me, do these questions and stuff always go to the same person or does it vary.
Brief Answer:
Upload images by consulting the help desk
Detailed Answer:
Hello,
You can consult help desk if you have difficulty in uploading images.
You are allowed to have three follow up with a specialist premium question and the query goes to the same doctor. After that you can get top up for additional questions.
If the thread of question is closed then if you want to consult the same doctor then you have to put a direct premium question on his name.
Upload images by consulting the help desk
Detailed Answer:
Hello,
You can consult help desk if you have difficulty in uploading images.
You are allowed to have three follow up with a specialist premium question and the query goes to the same doctor. After that you can get top up for additional questions.
If the thread of question is closed then if you want to consult the same doctor then you have to put a direct premium question on his name.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Continuity of Care Document - XXXXXXX XXXX (Female, born Jun. 15, 1963) As of Dec. 02, 2015
Patient Demographics
Patient Address Communication Language Race / Ethnicity
XXXX 50312
0000 (Home)
0000 (Home)
YYYY@YYYY
YYYY@YYYY
English (Preferred) White or Caucasian / Non-Hispanic or
Latino
Note from UnityPoint Health
This document contains information that was shared with XXXXXXX XXXX. It may not contain the entire record from UnityPoint Health.
Reason for Visit
Reason
Numbness
Encounter Details
Date Type Department Care Team
11/04/2015 -
11/06/2015
XXXX
Dr. XXXX
0000
0000 (Fax)
Dr. D XXXXXXX
XXXX
0000
0000 (Fax)
XXXX
0000
0000 (Fax)
Active Allergies and Adverse Reactions - as of 12/02/2015
Allergen Noted Date Severity Reactions Comments
Codeine 11/10/2015 Low Nausea Only
Lisinopril 01/07/2013 High Shortness Of Breath, Other (See
Comments)
Other reaction(s): Shortness of breath,
Nausea, Vomiting, Other
Low temperature, and hot flashes
Current Medications - as of 12/02/2015
Prescription Sig. Disp. Start Date End Date Status
MULTIPLE VITAMIN PO Take 1 tablet by mouth nightly. Active
nadolol (CORGARD) 20 MG tablet Take 1 tablet by mouth daily. 10/14/2013 Active
Insulin Aspart (NOVOLOG FLEXPEN)
100 UNIT/ML injection - pen
Inject 1-10 Units into the skin 3 (three)
times daily before meals. Per sliding
scale
3 pen 07/15/2015 Active
insulin glargine (LANTUS SOLOSTAR)
100 UNIT/ML SOPN injection - pen
Inject 52 Units into the skin nightly. 10/21/2015 Active
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab daily
90 tablet 11/06/2015 Active
glipiZIDE (GLUCOTROL) 10 MG tablet Take 10 mg by mouth. Active
Multiple Vitamins-Minerals
(MULTIVITAL PO)
Take 1 capsule by mouth daily. Active
vitamin B-12 (CYANOCOBALAMIN) 100
MCG tablet
Take 100 mcg by mouth daily. Active
albuterol (PROAIR HFA) 108 (90
BASE) MCG/ACT inhaler
Inhale 2 puffs into the lungs every 4
(four) hours as needed for Wheezing.
1 Inhaler 11/18/2015 Active
aspirin 81 MG tablet Take 1 tablet by mouth daily. 10/24/2012 11/06/2015 Discontinued
oxyCODONE-acetaminophen
(PERCOCET) 5-325 MG per tablet
Take 1-2 tablets by mouth every 6 (six)
hours as needed for Pain.
10 tablet 07/20/2015 11/10/2015 Discontinued
ibuprofen (ADVIL,MOTRIN) 600 MG
tablet
TAKE 1 TABLET BY MOUTH EVERY 6
HOURS AS NEEDED FOR FOR PAIN
385 tablet 07/21/2015 11/10/2015 Discontinued
liraglutide (VICTOZA) 18 MG/3ML
SOPN SC injection
Inject 1.2 mg into the skin daily. 10/21/2015 11/10/2015 Discontinued
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily. 30 tablet 11/06/2015 11/06/2015 Discontinued
clopidogrel (PLAVIX) 75 MG tablet TAKE 1 TABLET BY MOUTH DAILY 90 tablet 11/06/2015 11/06/2015 Discontinued
albuterol (PROAIR HFA) 108 (90
BASE) MCG/ACT inhaler
Inhale into the lungs. 11/18/2015 Discontinued
insulin glargine (LANTUS) 100 UNIT/ML
injection - vial
Inject 19 Units into the skin. 11/10/2015 Discontinued
Active Problems - as of 12/02/2015
Problem Noted Date
Stroke 11/04/2015
Type II or unspecified type diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled 09/02/2015
Problem Noted Date
Cataract 09/02/2015
Heavy periods 06/23/2015
Uterine fibroid 05/13/2015
Lumbar nerve root disorder 04/03/2015
Heavy periods 04/03/2015
Nasal inflammation due to allergen 11/24/2014
Acid reflux disease 11/24/2014
Dilated veins in stomach 05/20/2014
Vitamin D deficiency 04/14/2014
Increased pressure in the portal veins of the liver 04/07/2014
Blood clotting disorder 07/12/2013
Uterine fibroid 11/27/2012
Mesenteric venous thrombosis
Anxiety problem
High blood pressure
High cholesterol or triglycerides
Nicotine dependence
Polycythemia vera
Social History - as of 12/02/2015
Tobacco Use Types Packs/Day Years Used Date
Light tobacco smoker Cigarettes 0.5 35
Alcohol Use Drinks/Week oz/Week
No
Last Filed Vital Signs
Vital Sign Reading Time Taken
Blood Pressure 111/59 11/06/2015 3:30 PM CST
Pulse 87 11/06/2015 3:30 PM CST
Temperature 36.6 °C (97.8 °F) 11/06/2015 3:30 PM CST
Respiratory Rate 20 11/06/2015 3:30 PM CST
Height 1.676 m (5' 6") 11/04/2015 7:04 PM CST
Weight 79.198 kg (174 lb 9.6 oz) 11/06/2015 4:33 AM CST
Body Mass Index 28.19 11/06/2015 4:33 AM CST
Oxygen Saturation 98% 11/06/2015 3:30 PM CST
Functional Status
Functional Status Response
Are you deaf or do you have serious difficulty hearing? No
Are you blind or do you have serious difficulty seeing, even when wearing glasses? No
Do you have serious difficulty walking or climbing stairs? (5 years old or older) No
Do you have difficulty dressing or bathing? (5 years old or older) No
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a
doctor's office or shopping? (15 years old or older)
No
Cognitive Status Response
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or
making decisions? (5 years old or older)
No
Discharge Instructions
Nurse XXXXXXX L L - 11/05/2015
Because we care about you when you go home, you will receive a phone call from a patient care facilitator 1-3 days after you go home. If we can't reach you, we
may leave a message. You may also receive a call from your family doctor's office.
Home Instructions
Taking care of you:
· Wash your hands often with soap and water.
Call your doctor if:
? You have:
o sudden chest pain
o trouble breathing
o a feeling like your heart is pounding or racing
o pain that is getting worse and isn’t helped with medicine
o a fever higher than 101 F
o pain in the calf area of your leg
o gained weight:
· 3 pounds or more in 1 day
· 5 pounds or more in 1 week
o more swelling in your feet, legs, hands, or stomach
o numbness in arms or legs
o headache
? You feel:
o no energy or are very tired
o dizzy
o not hungry
o an upset stomach or throw up longer than 12 hours
o uneasy, like something is wrong
? Things are happening, like:
o trouble taking your medicines
o having a hard time following your doctor’s directions
If you have questions or concerns, call My UnityPoint Nurse at 0000 or call your doctor.
The following attachments were made available to the patient upon discharge.
CLOPIDOGREL (ENGLISH)
TIA (TRANSIENT ISCHEMIC ATTACK) (ENGLISH)
Medications at Time of Discharge
Medication Sig. Disp. Start Date End Date
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab
daily
90 tablet 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
100 UNIT/ML injection - pen
Inject 1-10 Units into the skin 3 (three)
times daily before meals. Per sliding
scale
3 pen 07/15/2015
insulin glargine (LANTUS SOLOSTAR)
100 UNIT/ML SOPN injection - pen
Inject 52 Units into the skin nightly. 10/21/2015
MULTIPLE VITAMIN PO Take 1 tablet by mouth nightly.
nadolol (CORGARD) 20 MG tablet Take 1 tablet by mouth daily. 10/14/2013
ibuprofen (ADVIL,MOTRIN) 600 MG
tablet
TAKE 1 TABLET BY MOUTH EVERY 6
HOURS AS NEEDED FOR FOR PAIN
385 tablet 07/21/2015 11/10/2015
liraglutide (VICTOZA) 18 MG/3ML
SOPN SC injection
Inject 1.2 mg into the skin daily. 10/21/2015 11/10/2015
oxyCODONE-acetaminophen
(PERCOCET) 5-325 MG per tablet
Take 1-2 tablets by mouth every 6 (six)
hours as needed for Pain.
10 tablet 07/20/2015 11/10/2015
Hospital, Clinic, or Other Facility
Administered Medication Ordered Dose Route Frequency Start Date End Date
acetaminophen (TYLENOL) tablet 650mg PO Q6H PRN 11/04/2015 11/06/2015
cloNIDine (CATAPRES) tablet 0.1mg PO Q6H PRN 11/04/2015 11/06/2015
clopidogrel (PLAVIX) tablet 75mg PO Daily 11/05/2015 11/06/2015
enoxaparin sodium (LOVENOX)
injection 40 mg
40mg SC Q24H 11/04/2015 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
injection - pen
1-5U SC 4 Times Daily AC and HS 11/04/2015 11/06/2015
insulin glargine (LANTUS SOLOSTAR)
injection - pen
52U SC Nightly 11/04/2015 11/06/2015
multivitamin (THERA) tablet 1{each} PO Daily 11/05/2015 11/06/2015
nadolol (CORGARD) tablet 20mg PO Daily 11/05/2015 11/06/2015
nicotine (NICODERM CQ) 21 MG/24HR 1{patch} TD Daily 11/05/2015 11/06/2015
ondansetron HCl (ZOFRAN) injection 4mg IV Q8H PRN 11/04/2015 11/06/2015
senna-docusate 8.6-50 MG per tablet 1{tbl} PO BID 11/04/2015 11/06/2015
simvastatin (ZOCOR) tablet 20mg PO Nightly 11/04/2015 11/06/2015
Prescriptions Ordered During Visit
Prescription Sig. Disp. Start Date End Date
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab
daily
90 tablet 11/06/2015
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily. 30 tablet 11/06/2015 11/06/2015
Plan of Care
Upcoming Encounters
Date Type Specialty Providers
12/21/2015 Appointment Internal Medicine XXXX
0000
0000 (Fax)
Results
IMAGE SCANNED RESULT - Final result (11/09/2015 6:53 AM CST)
EKG VIEW RHYTHM STRIP - Final result (11/09/2015 6:53 AM CST)
POCT GLUCOSE - Final result (11/06/2015 12:53 PM CST)
Component Value Range
Glucose, POC 223 70-100 mg/dL
POCT GLUCOSE - Final result (11/06/2015 9:28 AM CST)
Component Value Range
Glucose, POC 79 70-100 mg/dL
URINE MICROSCOPIC ONLY - Final result (11/05/2015 9:24 PM CST)
Component Value Range
RBC NONE SEEN 0-3 /hpf
WBC 0-5 0-5 /hpf
Component Value Range
Bacteria MANY >50 0 /hpf
Epithelial Cells MANY >10 0 /lpf
Hyaline Casts 0-5 0 /lpf
URINALYSIS AUTO ONLY (URINALYSIS) - Final result (11/05/2015 9:24 PM CST)
Component Value Range
Specimen CLN CATCH
Color YELLOW YELLOW
Clarity CLEAR CLEAR
Glucose >=1000 NEG mg/dL
Bilirubin NEG NEG
Ketones NEG NEG mg/dL
Specific Gravity 1.023 1.003-1.030
Blood NEG NEG
pH 6.0 5.0-8.0
Protein NEG NEG mg/dL
Urobilinogen 0.2 0.2-1.0 EU/dL
Nitrite NEG NEG
Leukocyte Esterase NEG NEG
URINALYSIS AUTO W/SCOPE (URINALYSIS WITH MICROSCOPIC) - Final result (11/05/2015 9:24 PM CST)
POCT GLUCOSE - Final result (11/05/2015 9:14 PM CST)
Component Value Range
Glucose, POC 345 70-100 mg/dL
POCT GLUCOSE - Final result (11/05/2015 5:41 PM CST)
Component Value Range
Glucose, POC 211 70-100 mg/dL
Us Carotid Duplex Scan Bilat (US CAROTID DUPLEX SCAN BILAT) - Final result (11/05/2015 2:44 PM CST)
Narrative
XXXX
Phone 0000
Fax 0000
Carotid Duplex Report
Name: XXXX, XXXXXXX XXXX Study Date: 11/05/2015 02:44 PM
MRN: 0000
DOB: XXXX Patient Type: Inpatient
Age: 52 yrs Patient Location: North 4
Reason For Study: TIA Ordering Physician: XXXXXXX XXXXXXX XXXX, DO Gender: Female
History: HTN, HLP, Nicotine dependence, DM
Interpretation Summary
There is plaque within both the right and left internal carotid arteries consistent with mild, less than 50% stenosis.
Vertebral flow is antegrade bilaterally.
Right Velocities Left Velocities
Proximal CCA = 77/23 cm/sec.
Distal CCA = 58/22 cm/sec.
Proximal ICA = 71/27 cm/sec.
Mid ICA = 73/34 cm/sec.
Distal ICA = 90/40 cm/sec.
Right ICA/CCA ratio = 1.55.
Proximal ECA = 96 cm/sec.
Right Vertebral = 48/11 cm/sec.
Right Brachial BP = 102 mmHg. Proximal CCA = 74/22 cm/sec.
Distal CCA = 57/22 cm/sec.
Bulb = 87/39 cm/sec.
Proximal ICA = 89/37 cm/sec.
Mid ICA = 121/49 cm/sec.
Distal ICA = 85/40 cm/sec.
Left ICA/CCA ratio = 2.12.
Proximal ECA = 87 cm/sec.
Left Vertebral = 73/28 cm/sec.
Left Brachial BP = 105 mmHg.
Right Extracranial
There is heterogeneous, irregular atherosclerotic plaque noted in the right common carotid artery. There is plaque within
the right common carotid artery consistent with a mild, less than 50%, stenosis. Flow velocity within the right internal
carotid
Narrative
artery is consistent with a stenosis less than 50%. Antegrade flow is noted in the right vertebral artery.
Left Extracranial
There is heterogeneous, irregular atherosclerotic plaque noted in the left common carotid artery. There is plaque within the
left common carotid artery consistent with a mild, less than 50%, stenosis. There is homogenous, smooth atherosclerotic
plaque
noted in the left internal carotid artery. Flow velocity within the left internal carotid artery is consistent with a
stenosis less than 50%. Antegrade flow is noted in the left vertebral artery.
Reading Physician:
Electronically Authenticated by XXXXXXX XXXX, M.D. on 11/05/2015 04:40 PM
Ordering Physician: XXXXXXX XXXXXXX XXXX
Referring Physician: XXXX, XXXXXXX XXXX, MD
Performed By: XXXX
TTE (TRANSTHORACIC ECHO) COMPLETE - Final result (11/05/2015 2:17 PM CST)
Narrative
XXXX
Phone 0000
Fax 0000
Echocardiogram Report
Name: XXXX, XXXXXXX XXXX Study Date: 11/05/2015 02:17 PM BP: 115/70 mmHg
MRN: 0000 HR: 76
DOB: XXXX Patient Type: Inpatient Height: 66 in
Age: 52 yrs Patient Location: North 4 Weight: 174 lb
Reason For Study: TIA Ordering Physician: XXXXXXX XXXXXXX Gender: Female BSA: 1.9 meters2
History: HTN, GERD, TIA, DM, nicotine
MMode/2D Measurements & Calculations
IVSd: 1.0 cm
LVIDd: 5.1 cm
LVIDs: 2.6 cm
LVPWd: 0.68 cm
FS: 48.6 %
EF(Teich): 79.7 %
Ao root diam: 2.8 cm
LA dimension: 3.2 cm
LA/Ao: 1.1
LVOT diam: 1.8 cm
EDV(MOD-sp4): 34.5 ml
ESV(MOD-sp4): 9.0 ml
EF(MOD-sp4): 73.9 %
EDV(MOD-sp2): 24.0 ml
ESV(MOD-sp2): 6.8 ml
EF(MOD-sp2): 71.7 %
SV(sp4-el): 25.6 ml
Doppler Measurements & Calculations
MV E XXXXXXX vel: 43.7 cm/sec
MV A XXXXXXX vel: 54.6 cm/sec
MV E/A: 0.80
MV P1/2t XXXXXXX vel: 43.7 cm/sec
MV P1/2t: 102.0 msec
MVA(P1/2t): 2.2 cm2
MV dec slope: 125.5 cm/sec2
Ao V2 max: 107.5 cm/sec
Ao XXXXXXX PG: 4.6 mmHg
Ao mean PG: 2.6 mmHg
AVA(I,D): 1.5 cm2
LV V1 XXXXXXX PG: 2.1 mmHg
LV V1 max: 73.2 cm/sec
PA V2 max: 94.8 cm/sec
PA XXXXXXX PG: 3.6 mmHg
Left Ventricle
The left ventricle is normal in size. Hyperdynamic left ventricular function. EF is estimated at 65%. No regional wall
motion abnormalities.
Right Ventricle
The right ventricle is normal size. The right ventricle is normal in size and function.
Narrative
Atria
The left atrial size is normal. The interatrial septum is intact with no evidence for an atrial septal defect. Normal right
atrial size.
Aorta/Pulmonary Artery
The aortic root is normal size. Arch normal. The pulmonary artery appears normal.
Aortic Valve
The aortic valve is trileaflet. There is no Aortic valve stenosis noted.
Mitral Valve
The mitral valve leaflets appear thickened, but open well.
Tricuspid Valve
The tricuspid valve leaflets are thin and pliable.
Pulmonic Valve
The pulmonic valve leaflets are thin and pliable; valve motion is normal.
Pulmonary Veins/IVC
The Pulmonary veins look normal in size. There is normal collapsability of the inferior vena cava with respiration.
Pericardium/Pleura
There is no pericardial effusion.
Interpretation Summary
EF is estimated at 65%.
No regional wall motion abnormalities
Reading Physician:
Electronically Authenticated by XXXXXXX XXXX, M.D. on 11/05/2015 04:33 PM
Performed By: XXXX, XXXXXXX XXXX, XXXX
POCT GLUCOSE - Final result (11/05/2015 1:28 PM CST)
Component Value Range
Glucose, POC 82 70-100 mg/dL
POCT GLUCOSE - Final result (11/05/2015 10:24 AM CST)
Component Value Range
Glucose, POC 66 70-100 mg/dL
BASIC METABOLIC PANEL - Final result (11/05/2015 6:22 AM CST)
Component Value Range
Sodium 142 136-145 mmol/L
Potassium 3.7 3.6-5.1 mmol/L
Chloride 106 98-109 mmol/L
CO2 27 23-30 mmol/L
Glucose 70 70-99 mg/dL
BUN, Blood 12 6-22 mg/dL
Creatinine, Serum 0.85
Comment: The analysis was performed using an isotope dilution mass
spectrometry (IDMS) traceable methodology.
0.7-1.3 mg/dL
Anion Gap 13 8-20 mmol/L
BUN/Creatinine Ratio 14.1
Calcium 9.2 8.8-10.3 mg/dL
GFR Estimate SEE NOTES
Comment:
>60
----
Greater than or equal to 60 mL/min/1.73 m2
The eGFR based on the MDRD Study equation is only useful
when renal function is stable and may not be suitable for
all populations.
This estimate is not recommended for patients with serious
co-morbid conditions, during pregnancy, older than 70 or
at the extremes of muscle mass or diet.
REFERENCE RANGES:
Chronic Kidney Disease - Less than 60 ml/min/1.73m2
Kidney Failure - Less than 15 ml/min/1.73m2
POCT GLUCOSE - Final result (11/05/2015 2:11 AM CST)
Component Value Range
Glucose, POC 90 70-100 mg/dL
Mr Angiography Head Wo Contrast (MR ANGIOGRAPHY HEAD WO CONTRAST) - Final result (11/04/2015 10:05 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX XXXX ACCOUNT#: 0000
MED REC #: 0000
DOB: XXXX
ORDERING PHY: XXXXXXX XXXXXXX XXXX DO XXXXXXX XXXXXXX XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: IP ORDER # XXXX
PATIENT LOCAT: XXXX(XXXX)
EXAM DATE: 11/04/2015 2205
11/04/2015 2204
================================================================
EXAM: MR BRAIN WO CONTRAST USUAL
MRA HEAD WO CONTRAST
EXAM: MR BRAIN without contrast; MRA HEAD, .
CLINICAL DATA: TIA, acute onset right arm numbness and tingling,
headache, confusion, overall weakness this morning.
COMPARISON: Head CT November 4, 2015; no prior MR brain or MRA head
for comparison.
TECHNIQUE: Multiplanar, multisequential MR images of the brain were
obtained without contrast. MRA of the head was performed utilizing
TOF. MIP reformatted images of the circle of Willis and its major
arterial branch points.
FINDINGS:
MR BRAIN: Scattered regions of cortical restricted diffusion in the
left frontal lobe, left parietal lobe, and left occipital lobe with
associated edema. Largest region of restricted diffusion is seen in
the left occipital lobe. Findings are compatible with acute infarcts.
Small foci of high signal at the margin of the posterior left
cerebellar hemisphere on DWI sequence (for example series 12, image
39) are artifactual.
No significant shift of midline structures or mass effect. No
hydrocephalus. The basal cisterns are grossly patent. Chronic ischemic
change in the central pons. Minimal additional periventricular white
matter FLAIR hyperintensities representing early chronic ischemic
change. Small arachnoid granulations in the left posterior calvarium.
MRA HEAD: Intracranial ICAs are patent without significant stenosis or
aneurysm. Bilateral PICAs are patent. Right intradural vertebral
artery is asymmetrically smaller and becomes more diminutive after the
branch of the right PICA representing anatomic variation. Left
intradural vertebral artery is patent and dominant with no significant
stenosis. Basilar artery is patent without significant stenosis or
aneurysm. PCAs are patent without significant stenosis or aneurysm.
MCAs are patent without significant stenosis or aneurysm. ACAs are
patent without significant stenosis or aneurysm. Anterior
communicating artery is patent..
IMPRESSION:
1. Acute cortical infarcts in the left frontal lobe, left parietal
lobe, and left occipital lobe. The position of the left cerebral
infarcts suggest a watershed distribution. Consider CTA neck to assess
carotid arteries.
2. Intracranial arterial system is patent with no significant stenosis
or aneurysm.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, XXXX
11/05/2015 10:12
DOCUMENT STATUS: Final
Mri Brain Wo Contrast (MRI BRAIN WO CONTRAST) - Final result (11/04/2015 10:05 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX XXXX ACCOUNT#: 0000
0000
DOB: 0000
ORDERING PHY: XXXXXXX XXXXXXX XXXX XXXXXXX XXXXXXX XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: IP ORDER # 15MMR6774
15MMR6775
PATIENT LOCAT: XXXX
EXAM DATE: 11/04/2015 2205
11/04/2015 2204
================================================================
EXAM: XXXX WO CONTRAST USUAL
MRA HEAD WO CONTRAST
EXAM:XXXX without contrast; MRA HEAD, .
CLINICAL DATA: TIA, acute onset right arm numbness and tingling,
headache, confusion, overall weakness this morning.
COMPARISON: Head CT November 4, 2015; no prior MR brain or MRA head
for comparison.
TECHNIQUE: Multiplanar, multisequential MR images of the brain were
obtained without contrast. MRA of the head was performed utilizing
TOF. MIP reformatted images of the circle of Willis and its major
arterial branch points.
FINDINGS:
MR XXXX: Scattered regions of cortical restricted diffusion in the
left frontal lobe, left parietal lobe, and left occipital lobe with
associated edema. Largest region of restricted diffusion is seen in
the left occipital lobe. Findings are compatible with acute infarcts.
Small foci of high signal at the margin of the posterior left
cerebellar hemisphere on DWI sequence (for example series 12, image
39) are artifactual.
No significant shift of midline structures or mass effect. No
hydrocephalus. The basal cisterns are grossly patent. Chronic ischemic
change in the central pons. Minimal additional periventricular white
matter FLAIR hyperintensities representing early chronic ischemic
change. Small arachnoid granulations in the left posterior calvarium.
MRA HEAD: Intracranial ICAs are patent without significant stenosis or
aneurysm. Bilateral PICAs are patent. Right intradural vertebral
artery is asymmetrically smaller and becomes more diminutive after the
branch of the right PICA representing anatomic variation. Left
intradural vertebral artery is patent and dominant with no significant
stenosis. Basilar artery is patent without significant stenosis or
aneurysm. PCAs are patent without significant stenosis or aneurysm.
MCAs are patent without significant stenosis or aneurysm. ACAs are
patent without significant stenosis or aneurysm. Anterior
communicating artery is patent..
IMPRESSION:
1. Acute cortical infarcts in the left frontal lobe, left parietal
lobe, and left occipital lobe. The position of the left cerebral
infarcts suggest a watershed distribution. Consider CTA neck to assess
carotid arteries.
2. Intracranial arterial system is patent with no significant stenosis
or aneurysm.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, XXXX
11/05/2015 10:12
DOCUMENT STATUS: Final
POCT GLUCOSE - Final result (11/04/2015 9:00 PM CST)
Component Value Range
Glucose, POC 135 70-100 mg/dL
HEMOGLOBIN A1C - Final result (11/04/2015 7:33 PM CST)
Component Value Range
Hemoglobin A1C
5.4
Comment:
----
5.7-6.4%
Increased risk of diabetes.
----
Greater than 6.4%
Diagnostic of diabetes.
----
Less than 7%
Meets treatment goal of ADA.
----
Note change in reference range based on ADA guidelines.
0-5.7 %
Estimated Avg Gluc 108
Comment: The "Estimated Average Glucose" is an estimate of the patient's
glucose level over the last 60 days, based on the HgbA1c value.
mg/dL
LIPID PANEL - Final result (11/04/2015 7:33 PM CST)
Component Value Range
Cholesterol 167 0-200 mg/dL
Triglycerides 257 0-150 mg/dL
HDL 38 >50 mg/dL
LDL
78
Comment:
----
Classification:
< 100 mg/dL: Desirable LDL
100-129 mg/dL: Borderline LDL
130-159 mg/dL: Borderline High LDL
160-189 mg/dL: High Risk LDL
> 189 mg/dL: Very High Risk LDL
<100 mg/dL
VLDL 51 <30 mg/dL
Chol/HDL Ratio 4.4
Comment:
----
Classification:
<5.0 Goal
<3.0 Ideal
----
Highest acceptable and optimal values of cholesterol vary
with age. Values above 240 mg/dL are associated with
increased risk of coronary heart disease regardless of HDL
or LDL values.
----
Elevations of triglycerides can be seen with: (1) obesity
(2) medications (3) less than 12 hour fast (4) alcohol
intake (5) birth control medications.
----
Increased LDL cholesterol levels are associated with
increased coronary heart disease.
----
LDL/HDL ratio can be falsely elevated when patient has not
had a 12 hour fast prior to blood sampling.
----
The XXXXXXX Heart Association and the National Institute
of Health consider cholesterol levels below 200 mg/dL
desirable.
EKG VIEW FINAL - Final result (11/04/2015 7:28 PM CST)
Ct Head Or Brain Wo Contrast (CT HEAD OR BRAIN WO CONTRAST) - Final result (11/04/2015 2:54 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX L ACCOUNT#: 0000
MED REC #: 0000
DOB: XXXX
ORDERING PHY: XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: ER ORDER # XXXX
PATIENT LOCAT: XXXX (EMERGENCY DEPARTMENT
EXAM DATE: 11/04/2015 1454
================================================================
Narrative
EXAM: CT HEAD WO CONTRAST
CT BRAIN WITHOUT CONTRAST
INDICATION: Headache and right upper shunt and weakness.
COMPARISON: None.
TECHNIQUE: Multiple axial images of the brain were performed without
intravenous contrast.
FINDINGS: There is no acute intracranial hemorrhage, mass effect or
midline shift. The gray-white matter differentiation is intact. There
are no acute extra-axial fluid collections. The ventricles and sulci
are normal. There is no effacement of the basal cisterns. No calvarial
fracture.
IMPRESSION: No acute intracranial process.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, DO
11/04/2015 15:03
DOCUMENT STATUS: Final
TROPONIN I - Final result (11/04/2015 2:30 PM CST)
Component Value Range
Troponin I
<0.01
Comment:
----
Normal Value <0.05
Indeterminate Range 0.05-0.77
Acute Myocardial Infarction >0.78
0-0.78 ng/mL
COMPREHENSIVE METABOLIC PANEL - Final result (11/04/2015 2:30 PM CST)
Component Value Range
Sodium 135 136-145 mmol/L
Potassium 3.8 3.6-5.1 mmol/L
Chloride 98 98-109 mmol/L
CO2 29 23-30 mmol/L
Glucose 291 70-99 mg/dL
BUN, Blood 15 6-22 mg/dL
Creatinine, Serum 0.84
Comment: The analysis was performed using an isotope dilution mass
spectrometry (IDMS) traceable methodology.
0.7-1.3 mg/dL
Calcium 10.2 8.8-10.3 mg/dL
Total Protein 7.2 6.4-8.0 g/dL
Albumin 4.0 3.5-4.8 g/dL
Total Bilirubin 0.8 0.4-1.3 mg/dL
Alkaline Phosphatase 91 25-105 U/L
AST 55 13-38 U/L
Anion Gap 12 8-20 mmol/L
ALT 40 0-40 U/L
GFR Estimate SEE NOTES
Comment:
>60
----
Greater than or equal to 60 mL/min/1.73 m2
The eGFR based on the MDRD Study equation is only useful
when renal function is stable and may not be suitable for
all populations.
This estimate is not recommended for patients with serious
co-morbid conditions, during pregnancy, older than 70 or
at the extremes of muscle mass or diet.
REFERENCE RANGES:
Chronic Kidney Disease - Less than 60 ml/min/1.73m2
Kidney Failure - Less than 15 ml/min/1.73m2
CBC (CBC (HEMOGRAM)) - Final result (11/04/2015 2:30 PM CST)
Component Value Range
WBC 7.63 4.00-11.00 th/mm3
RBC 4.62 4.20-5.20 mill/mm3
Hemoglobin 15.1 12.0-16.0 g/dL
Hematocrit 41.6 37.0-47.0 %
Component Value Range
MCV 90.0 81.0-98.0 fL
MCH 32.7 27.0-34.0 pg
MCHC 36.3 31.5-36.0 g/dL
Platelets 414 150-450 th/mm3
RDWSD 43.8 36.4-46.3 fL
RDW 13.3 9.0-14.5 %
MPV 9.7 8.7-12.6 fL
NRBC Absolute 0.00 0.0 th/mm3
NRBC % 0.0 0.0 %
ISTAT TROPONIN I - Final result (11/04/2015 2:29 PM CST)
Component Value Range
Troponin I, I-Stat 0.00 <0.08 ng/mL
EKG 12-LEAD - Final result (11/04/2015 2:19 PM CST)
Visit Diagnoses
Temporary loss of blood supply to brain - Primary
Admitting Diagnoses
Temporary loss of blood supply to brain
Administered Medications
Medication Ordered Dose Route Frequency Start Date End Date
nicotine (NICODERM CQ) 21 MG/24HR 1{patch} TD Daily 11/05/2015 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
injection - pen
1-5U SC 4 Times Daily AC and HS 11/04/2015 11/06/2015
clopidogrel (PLAVIX) tablet 75mg PO Daily 11/05/2015 11/06/2015
simvastatin (ZOCOR) tablet 20mg PO Nightly 11/04/2015 11/06/2015
senna-docusate 8.6-50 MG per tablet 1{tbl} PO BID 11/04/2015 11/06/2015
acetaminophen (TYLENOL) tablet 650mg PO Q6H PRN 11/04/2015 11/06/2015
enoxaparin sodium (LOVENOX)
injection 40 mg
40mg SC Q24H 11/04/2015 11/06/2015
nadolol (CORGARD) tablet 20mg PO Daily 11/05/2015 11/06/2015
multivitamin (THERA) tablet 1{each} PO Daily 11/05/2015 11/06/2015
insulin glargine (LANTUS SOLOSTAR)
injection - pen
52U SC Nightly 11/04/2015 11/06/2015
sodium chloride 0.9 % bolus 1,000 mL 1000mL IV Once 11/04/2015 11/04/2015
diphenhydrAMINE (BENADRYL)
injection
25mg IV Once 11/04/2015 11/04/2015
prochlorperazine (COMPAZINE)
injection
5mg IV Once 11/04/2015 11/04/2015
Document Information
Primary Care Provider
S XXXX (Sep. 30, 2013 - Present)
0000 (Zork)
0000 (Fax)
XXXX
Document Coverage Dates
Nov. 04, 2015 - Nov. 06, 2015
Custodian Organization
UnityPoint Health
XXXX
D XXXXXXX (Admitting)
0000 (Work)
0000 (Fax)
XXXX
Encounter Date
Nov. 04, 2015 - Nov. 06, 2015
Patient Demographics
Patient Address Communication Language Race / Ethnicity
XXXX 50312
0000 (Home)
0000 (Home)
YYYY@YYYY
YYYY@YYYY
English (Preferred) White or Caucasian / Non-Hispanic or
Latino
Note from UnityPoint Health
This document contains information that was shared with XXXXXXX XXXX. It may not contain the entire record from UnityPoint Health.
Reason for Visit
Reason
Numbness
Encounter Details
Date Type Department Care Team
11/04/2015 -
11/06/2015
XXXX
Dr. XXXX
0000
0000 (Fax)
Dr. D XXXXXXX
XXXX
0000
0000 (Fax)
XXXX
0000
0000 (Fax)
Active Allergies and Adverse Reactions - as of 12/02/2015
Allergen Noted Date Severity Reactions Comments
Codeine 11/10/2015 Low Nausea Only
Lisinopril 01/07/2013 High Shortness Of Breath, Other (See
Comments)
Other reaction(s): Shortness of breath,
Nausea, Vomiting, Other
Low temperature, and hot flashes
Current Medications - as of 12/02/2015
Prescription Sig. Disp. Start Date End Date Status
MULTIPLE VITAMIN PO Take 1 tablet by mouth nightly. Active
nadolol (CORGARD) 20 MG tablet Take 1 tablet by mouth daily. 10/14/2013 Active
Insulin Aspart (NOVOLOG FLEXPEN)
100 UNIT/ML injection - pen
Inject 1-10 Units into the skin 3 (three)
times daily before meals. Per sliding
scale
3 pen 07/15/2015 Active
insulin glargine (LANTUS SOLOSTAR)
100 UNIT/ML SOPN injection - pen
Inject 52 Units into the skin nightly. 10/21/2015 Active
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab daily
90 tablet 11/06/2015 Active
glipiZIDE (GLUCOTROL) 10 MG tablet Take 10 mg by mouth. Active
Multiple Vitamins-Minerals
(MULTIVITAL PO)
Take 1 capsule by mouth daily. Active
vitamin B-12 (CYANOCOBALAMIN) 100
MCG tablet
Take 100 mcg by mouth daily. Active
albuterol (PROAIR HFA) 108 (90
BASE) MCG/ACT inhaler
Inhale 2 puffs into the lungs every 4
(four) hours as needed for Wheezing.
1 Inhaler 11/18/2015 Active
aspirin 81 MG tablet Take 1 tablet by mouth daily. 10/24/2012 11/06/2015 Discontinued
oxyCODONE-acetaminophen
(PERCOCET) 5-325 MG per tablet
Take 1-2 tablets by mouth every 6 (six)
hours as needed for Pain.
10 tablet 07/20/2015 11/10/2015 Discontinued
ibuprofen (ADVIL,MOTRIN) 600 MG
tablet
TAKE 1 TABLET BY MOUTH EVERY 6
HOURS AS NEEDED FOR FOR PAIN
385 tablet 07/21/2015 11/10/2015 Discontinued
liraglutide (VICTOZA) 18 MG/3ML
SOPN SC injection
Inject 1.2 mg into the skin daily. 10/21/2015 11/10/2015 Discontinued
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily. 30 tablet 11/06/2015 11/06/2015 Discontinued
clopidogrel (PLAVIX) 75 MG tablet TAKE 1 TABLET BY MOUTH DAILY 90 tablet 11/06/2015 11/06/2015 Discontinued
albuterol (PROAIR HFA) 108 (90
BASE) MCG/ACT inhaler
Inhale into the lungs. 11/18/2015 Discontinued
insulin glargine (LANTUS) 100 UNIT/ML
injection - vial
Inject 19 Units into the skin. 11/10/2015 Discontinued
Active Problems - as of 12/02/2015
Problem Noted Date
Stroke 11/04/2015
Type II or unspecified type diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled 09/02/2015
Problem Noted Date
Cataract 09/02/2015
Heavy periods 06/23/2015
Uterine fibroid 05/13/2015
Lumbar nerve root disorder 04/03/2015
Heavy periods 04/03/2015
Nasal inflammation due to allergen 11/24/2014
Acid reflux disease 11/24/2014
Dilated veins in stomach 05/20/2014
Vitamin D deficiency 04/14/2014
Increased pressure in the portal veins of the liver 04/07/2014
Blood clotting disorder 07/12/2013
Uterine fibroid 11/27/2012
Mesenteric venous thrombosis
Anxiety problem
High blood pressure
High cholesterol or triglycerides
Nicotine dependence
Polycythemia vera
Social History - as of 12/02/2015
Tobacco Use Types Packs/Day Years Used Date
Light tobacco smoker Cigarettes 0.5 35
Alcohol Use Drinks/Week oz/Week
No
Last Filed Vital Signs
Vital Sign Reading Time Taken
Blood Pressure 111/59 11/06/2015 3:30 PM CST
Pulse 87 11/06/2015 3:30 PM CST
Temperature 36.6 °C (97.8 °F) 11/06/2015 3:30 PM CST
Respiratory Rate 20 11/06/2015 3:30 PM CST
Height 1.676 m (5' 6") 11/04/2015 7:04 PM CST
Weight 79.198 kg (174 lb 9.6 oz) 11/06/2015 4:33 AM CST
Body Mass Index 28.19 11/06/2015 4:33 AM CST
Oxygen Saturation 98% 11/06/2015 3:30 PM CST
Functional Status
Functional Status Response
Are you deaf or do you have serious difficulty hearing? No
Are you blind or do you have serious difficulty seeing, even when wearing glasses? No
Do you have serious difficulty walking or climbing stairs? (5 years old or older) No
Do you have difficulty dressing or bathing? (5 years old or older) No
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a
doctor's office or shopping? (15 years old or older)
No
Cognitive Status Response
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or
making decisions? (5 years old or older)
No
Discharge Instructions
Nurse XXXXXXX L L - 11/05/2015
Because we care about you when you go home, you will receive a phone call from a patient care facilitator 1-3 days after you go home. If we can't reach you, we
may leave a message. You may also receive a call from your family doctor's office.
Home Instructions
Taking care of you:
· Wash your hands often with soap and water.
Call your doctor if:
? You have:
o sudden chest pain
o trouble breathing
o a feeling like your heart is pounding or racing
o pain that is getting worse and isn’t helped with medicine
o a fever higher than 101 F
o pain in the calf area of your leg
o gained weight:
· 3 pounds or more in 1 day
· 5 pounds or more in 1 week
o more swelling in your feet, legs, hands, or stomach
o numbness in arms or legs
o headache
? You feel:
o no energy or are very tired
o dizzy
o not hungry
o an upset stomach or throw up longer than 12 hours
o uneasy, like something is wrong
? Things are happening, like:
o trouble taking your medicines
o having a hard time following your doctor’s directions
If you have questions or concerns, call My UnityPoint Nurse at 0000 or call your doctor.
The following attachments were made available to the patient upon discharge.
CLOPIDOGREL (ENGLISH)
TIA (TRANSIENT ISCHEMIC ATTACK) (ENGLISH)
Medications at Time of Discharge
Medication Sig. Disp. Start Date End Date
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab
daily
90 tablet 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
100 UNIT/ML injection - pen
Inject 1-10 Units into the skin 3 (three)
times daily before meals. Per sliding
scale
3 pen 07/15/2015
insulin glargine (LANTUS SOLOSTAR)
100 UNIT/ML SOPN injection - pen
Inject 52 Units into the skin nightly. 10/21/2015
MULTIPLE VITAMIN PO Take 1 tablet by mouth nightly.
nadolol (CORGARD) 20 MG tablet Take 1 tablet by mouth daily. 10/14/2013
ibuprofen (ADVIL,MOTRIN) 600 MG
tablet
TAKE 1 TABLET BY MOUTH EVERY 6
HOURS AS NEEDED FOR FOR PAIN
385 tablet 07/21/2015 11/10/2015
liraglutide (VICTOZA) 18 MG/3ML
SOPN SC injection
Inject 1.2 mg into the skin daily. 10/21/2015 11/10/2015
oxyCODONE-acetaminophen
(PERCOCET) 5-325 MG per tablet
Take 1-2 tablets by mouth every 6 (six)
hours as needed for Pain.
10 tablet 07/20/2015 11/10/2015
Hospital, Clinic, or Other Facility
Administered Medication Ordered Dose Route Frequency Start Date End Date
acetaminophen (TYLENOL) tablet 650mg PO Q6H PRN 11/04/2015 11/06/2015
cloNIDine (CATAPRES) tablet 0.1mg PO Q6H PRN 11/04/2015 11/06/2015
clopidogrel (PLAVIX) tablet 75mg PO Daily 11/05/2015 11/06/2015
enoxaparin sodium (LOVENOX)
injection 40 mg
40mg SC Q24H 11/04/2015 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
injection - pen
1-5U SC 4 Times Daily AC and HS 11/04/2015 11/06/2015
insulin glargine (LANTUS SOLOSTAR)
injection - pen
52U SC Nightly 11/04/2015 11/06/2015
multivitamin (THERA) tablet 1{each} PO Daily 11/05/2015 11/06/2015
nadolol (CORGARD) tablet 20mg PO Daily 11/05/2015 11/06/2015
nicotine (NICODERM CQ) 21 MG/24HR 1{patch} TD Daily 11/05/2015 11/06/2015
ondansetron HCl (ZOFRAN) injection 4mg IV Q8H PRN 11/04/2015 11/06/2015
senna-docusate 8.6-50 MG per tablet 1{tbl} PO BID 11/04/2015 11/06/2015
simvastatin (ZOCOR) tablet 20mg PO Nightly 11/04/2015 11/06/2015
Prescriptions Ordered During Visit
Prescription Sig. Disp. Start Date End Date
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily.
Disregard one of these Plavix RXs.
He is to take total of 75 mg 1 tab
daily
90 tablet 11/06/2015
clopidogrel (PLAVIX) 75 MG tablet Take 1 tablet by mouth daily. 30 tablet 11/06/2015 11/06/2015
Plan of Care
Upcoming Encounters
Date Type Specialty Providers
12/21/2015 Appointment Internal Medicine XXXX
0000
0000 (Fax)
Results
IMAGE SCANNED RESULT - Final result (11/09/2015 6:53 AM CST)
EKG VIEW RHYTHM STRIP - Final result (11/09/2015 6:53 AM CST)
POCT GLUCOSE - Final result (11/06/2015 12:53 PM CST)
Component Value Range
Glucose, POC 223 70-100 mg/dL
POCT GLUCOSE - Final result (11/06/2015 9:28 AM CST)
Component Value Range
Glucose, POC 79 70-100 mg/dL
URINE MICROSCOPIC ONLY - Final result (11/05/2015 9:24 PM CST)
Component Value Range
RBC NONE SEEN 0-3 /hpf
WBC 0-5 0-5 /hpf
Component Value Range
Bacteria MANY >50 0 /hpf
Epithelial Cells MANY >10 0 /lpf
Hyaline Casts 0-5 0 /lpf
URINALYSIS AUTO ONLY (URINALYSIS) - Final result (11/05/2015 9:24 PM CST)
Component Value Range
Specimen CLN CATCH
Color YELLOW YELLOW
Clarity CLEAR CLEAR
Glucose >=1000 NEG mg/dL
Bilirubin NEG NEG
Ketones NEG NEG mg/dL
Specific Gravity 1.023 1.003-1.030
Blood NEG NEG
pH 6.0 5.0-8.0
Protein NEG NEG mg/dL
Urobilinogen 0.2 0.2-1.0 EU/dL
Nitrite NEG NEG
Leukocyte Esterase NEG NEG
URINALYSIS AUTO W/SCOPE (URINALYSIS WITH MICROSCOPIC) - Final result (11/05/2015 9:24 PM CST)
POCT GLUCOSE - Final result (11/05/2015 9:14 PM CST)
Component Value Range
Glucose, POC 345 70-100 mg/dL
POCT GLUCOSE - Final result (11/05/2015 5:41 PM CST)
Component Value Range
Glucose, POC 211 70-100 mg/dL
Us Carotid Duplex Scan Bilat (US CAROTID DUPLEX SCAN BILAT) - Final result (11/05/2015 2:44 PM CST)
Narrative
XXXX
Phone 0000
Fax 0000
Carotid Duplex Report
Name: XXXX, XXXXXXX XXXX Study Date: 11/05/2015 02:44 PM
MRN: 0000
DOB: XXXX Patient Type: Inpatient
Age: 52 yrs Patient Location: North 4
Reason For Study: TIA Ordering Physician: XXXXXXX XXXXXXX XXXX, DO Gender: Female
History: HTN, HLP, Nicotine dependence, DM
Interpretation Summary
There is plaque within both the right and left internal carotid arteries consistent with mild, less than 50% stenosis.
Vertebral flow is antegrade bilaterally.
Right Velocities Left Velocities
Proximal CCA = 77/23 cm/sec.
Distal CCA = 58/22 cm/sec.
Proximal ICA = 71/27 cm/sec.
Mid ICA = 73/34 cm/sec.
Distal ICA = 90/40 cm/sec.
Right ICA/CCA ratio = 1.55.
Proximal ECA = 96 cm/sec.
Right Vertebral = 48/11 cm/sec.
Right Brachial BP = 102 mmHg. Proximal CCA = 74/22 cm/sec.
Distal CCA = 57/22 cm/sec.
Bulb = 87/39 cm/sec.
Proximal ICA = 89/37 cm/sec.
Mid ICA = 121/49 cm/sec.
Distal ICA = 85/40 cm/sec.
Left ICA/CCA ratio = 2.12.
Proximal ECA = 87 cm/sec.
Left Vertebral = 73/28 cm/sec.
Left Brachial BP = 105 mmHg.
Right Extracranial
There is heterogeneous, irregular atherosclerotic plaque noted in the right common carotid artery. There is plaque within
the right common carotid artery consistent with a mild, less than 50%, stenosis. Flow velocity within the right internal
carotid
Narrative
artery is consistent with a stenosis less than 50%. Antegrade flow is noted in the right vertebral artery.
Left Extracranial
There is heterogeneous, irregular atherosclerotic plaque noted in the left common carotid artery. There is plaque within the
left common carotid artery consistent with a mild, less than 50%, stenosis. There is homogenous, smooth atherosclerotic
plaque
noted in the left internal carotid artery. Flow velocity within the left internal carotid artery is consistent with a
stenosis less than 50%. Antegrade flow is noted in the left vertebral artery.
Reading Physician:
Electronically Authenticated by XXXXXXX XXXX, M.D. on 11/05/2015 04:40 PM
Ordering Physician: XXXXXXX XXXXXXX XXXX
Referring Physician: XXXX, XXXXXXX XXXX, MD
Performed By: XXXX
TTE (TRANSTHORACIC ECHO) COMPLETE - Final result (11/05/2015 2:17 PM CST)
Narrative
XXXX
Phone 0000
Fax 0000
Echocardiogram Report
Name: XXXX, XXXXXXX XXXX Study Date: 11/05/2015 02:17 PM BP: 115/70 mmHg
MRN: 0000 HR: 76
DOB: XXXX Patient Type: Inpatient Height: 66 in
Age: 52 yrs Patient Location: North 4 Weight: 174 lb
Reason For Study: TIA Ordering Physician: XXXXXXX XXXXXXX Gender: Female BSA: 1.9 meters2
History: HTN, GERD, TIA, DM, nicotine
MMode/2D Measurements & Calculations
IVSd: 1.0 cm
LVIDd: 5.1 cm
LVIDs: 2.6 cm
LVPWd: 0.68 cm
FS: 48.6 %
EF(Teich): 79.7 %
Ao root diam: 2.8 cm
LA dimension: 3.2 cm
LA/Ao: 1.1
LVOT diam: 1.8 cm
EDV(MOD-sp4): 34.5 ml
ESV(MOD-sp4): 9.0 ml
EF(MOD-sp4): 73.9 %
EDV(MOD-sp2): 24.0 ml
ESV(MOD-sp2): 6.8 ml
EF(MOD-sp2): 71.7 %
SV(sp4-el): 25.6 ml
Doppler Measurements & Calculations
MV E XXXXXXX vel: 43.7 cm/sec
MV A XXXXXXX vel: 54.6 cm/sec
MV E/A: 0.80
MV P1/2t XXXXXXX vel: 43.7 cm/sec
MV P1/2t: 102.0 msec
MVA(P1/2t): 2.2 cm2
MV dec slope: 125.5 cm/sec2
Ao V2 max: 107.5 cm/sec
Ao XXXXXXX PG: 4.6 mmHg
Ao mean PG: 2.6 mmHg
AVA(I,D): 1.5 cm2
LV V1 XXXXXXX PG: 2.1 mmHg
LV V1 max: 73.2 cm/sec
PA V2 max: 94.8 cm/sec
PA XXXXXXX PG: 3.6 mmHg
Left Ventricle
The left ventricle is normal in size. Hyperdynamic left ventricular function. EF is estimated at 65%. No regional wall
motion abnormalities.
Right Ventricle
The right ventricle is normal size. The right ventricle is normal in size and function.
Narrative
Atria
The left atrial size is normal. The interatrial septum is intact with no evidence for an atrial septal defect. Normal right
atrial size.
Aorta/Pulmonary Artery
The aortic root is normal size. Arch normal. The pulmonary artery appears normal.
Aortic Valve
The aortic valve is trileaflet. There is no Aortic valve stenosis noted.
Mitral Valve
The mitral valve leaflets appear thickened, but open well.
Tricuspid Valve
The tricuspid valve leaflets are thin and pliable.
Pulmonic Valve
The pulmonic valve leaflets are thin and pliable; valve motion is normal.
Pulmonary Veins/IVC
The Pulmonary veins look normal in size. There is normal collapsability of the inferior vena cava with respiration.
Pericardium/Pleura
There is no pericardial effusion.
Interpretation Summary
EF is estimated at 65%.
No regional wall motion abnormalities
Reading Physician:
Electronically Authenticated by XXXXXXX XXXX, M.D. on 11/05/2015 04:33 PM
Performed By: XXXX, XXXXXXX XXXX, XXXX
POCT GLUCOSE - Final result (11/05/2015 1:28 PM CST)
Component Value Range
Glucose, POC 82 70-100 mg/dL
POCT GLUCOSE - Final result (11/05/2015 10:24 AM CST)
Component Value Range
Glucose, POC 66 70-100 mg/dL
BASIC METABOLIC PANEL - Final result (11/05/2015 6:22 AM CST)
Component Value Range
Sodium 142 136-145 mmol/L
Potassium 3.7 3.6-5.1 mmol/L
Chloride 106 98-109 mmol/L
CO2 27 23-30 mmol/L
Glucose 70 70-99 mg/dL
BUN, Blood 12 6-22 mg/dL
Creatinine, Serum 0.85
Comment: The analysis was performed using an isotope dilution mass
spectrometry (IDMS) traceable methodology.
0.7-1.3 mg/dL
Anion Gap 13 8-20 mmol/L
BUN/Creatinine Ratio 14.1
Calcium 9.2 8.8-10.3 mg/dL
GFR Estimate SEE NOTES
Comment:
>60
----
Greater than or equal to 60 mL/min/1.73 m2
The eGFR based on the MDRD Study equation is only useful
when renal function is stable and may not be suitable for
all populations.
This estimate is not recommended for patients with serious
co-morbid conditions, during pregnancy, older than 70 or
at the extremes of muscle mass or diet.
REFERENCE RANGES:
Chronic Kidney Disease - Less than 60 ml/min/1.73m2
Kidney Failure - Less than 15 ml/min/1.73m2
POCT GLUCOSE - Final result (11/05/2015 2:11 AM CST)
Component Value Range
Glucose, POC 90 70-100 mg/dL
Mr Angiography Head Wo Contrast (MR ANGIOGRAPHY HEAD WO CONTRAST) - Final result (11/04/2015 10:05 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX XXXX ACCOUNT#: 0000
MED REC #: 0000
DOB: XXXX
ORDERING PHY: XXXXXXX XXXXXXX XXXX DO XXXXXXX XXXXXXX XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: IP ORDER # XXXX
PATIENT LOCAT: XXXX(XXXX)
EXAM DATE: 11/04/2015 2205
11/04/2015 2204
================================================================
EXAM: MR BRAIN WO CONTRAST USUAL
MRA HEAD WO CONTRAST
EXAM: MR BRAIN without contrast; MRA HEAD, .
CLINICAL DATA: TIA, acute onset right arm numbness and tingling,
headache, confusion, overall weakness this morning.
COMPARISON: Head CT November 4, 2015; no prior MR brain or MRA head
for comparison.
TECHNIQUE: Multiplanar, multisequential MR images of the brain were
obtained without contrast. MRA of the head was performed utilizing
TOF. MIP reformatted images of the circle of Willis and its major
arterial branch points.
FINDINGS:
MR BRAIN: Scattered regions of cortical restricted diffusion in the
left frontal lobe, left parietal lobe, and left occipital lobe with
associated edema. Largest region of restricted diffusion is seen in
the left occipital lobe. Findings are compatible with acute infarcts.
Small foci of high signal at the margin of the posterior left
cerebellar hemisphere on DWI sequence (for example series 12, image
39) are artifactual.
No significant shift of midline structures or mass effect. No
hydrocephalus. The basal cisterns are grossly patent. Chronic ischemic
change in the central pons. Minimal additional periventricular white
matter FLAIR hyperintensities representing early chronic ischemic
change. Small arachnoid granulations in the left posterior calvarium.
MRA HEAD: Intracranial ICAs are patent without significant stenosis or
aneurysm. Bilateral PICAs are patent. Right intradural vertebral
artery is asymmetrically smaller and becomes more diminutive after the
branch of the right PICA representing anatomic variation. Left
intradural vertebral artery is patent and dominant with no significant
stenosis. Basilar artery is patent without significant stenosis or
aneurysm. PCAs are patent without significant stenosis or aneurysm.
MCAs are patent without significant stenosis or aneurysm. ACAs are
patent without significant stenosis or aneurysm. Anterior
communicating artery is patent..
IMPRESSION:
1. Acute cortical infarcts in the left frontal lobe, left parietal
lobe, and left occipital lobe. The position of the left cerebral
infarcts suggest a watershed distribution. Consider CTA neck to assess
carotid arteries.
2. Intracranial arterial system is patent with no significant stenosis
or aneurysm.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, XXXX
11/05/2015 10:12
DOCUMENT STATUS: Final
Mri Brain Wo Contrast (MRI BRAIN WO CONTRAST) - Final result (11/04/2015 10:05 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX XXXX ACCOUNT#: 0000
0000
DOB: 0000
ORDERING PHY: XXXXXXX XXXXXXX XXXX XXXXXXX XXXXXXX XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: IP ORDER # 15MMR6774
15MMR6775
PATIENT LOCAT: XXXX
EXAM DATE: 11/04/2015 2205
11/04/2015 2204
================================================================
EXAM: XXXX WO CONTRAST USUAL
MRA HEAD WO CONTRAST
EXAM:XXXX without contrast; MRA HEAD, .
CLINICAL DATA: TIA, acute onset right arm numbness and tingling,
headache, confusion, overall weakness this morning.
COMPARISON: Head CT November 4, 2015; no prior MR brain or MRA head
for comparison.
TECHNIQUE: Multiplanar, multisequential MR images of the brain were
obtained without contrast. MRA of the head was performed utilizing
TOF. MIP reformatted images of the circle of Willis and its major
arterial branch points.
FINDINGS:
MR XXXX: Scattered regions of cortical restricted diffusion in the
left frontal lobe, left parietal lobe, and left occipital lobe with
associated edema. Largest region of restricted diffusion is seen in
the left occipital lobe. Findings are compatible with acute infarcts.
Small foci of high signal at the margin of the posterior left
cerebellar hemisphere on DWI sequence (for example series 12, image
39) are artifactual.
No significant shift of midline structures or mass effect. No
hydrocephalus. The basal cisterns are grossly patent. Chronic ischemic
change in the central pons. Minimal additional periventricular white
matter FLAIR hyperintensities representing early chronic ischemic
change. Small arachnoid granulations in the left posterior calvarium.
MRA HEAD: Intracranial ICAs are patent without significant stenosis or
aneurysm. Bilateral PICAs are patent. Right intradural vertebral
artery is asymmetrically smaller and becomes more diminutive after the
branch of the right PICA representing anatomic variation. Left
intradural vertebral artery is patent and dominant with no significant
stenosis. Basilar artery is patent without significant stenosis or
aneurysm. PCAs are patent without significant stenosis or aneurysm.
MCAs are patent without significant stenosis or aneurysm. ACAs are
patent without significant stenosis or aneurysm. Anterior
communicating artery is patent..
IMPRESSION:
1. Acute cortical infarcts in the left frontal lobe, left parietal
lobe, and left occipital lobe. The position of the left cerebral
infarcts suggest a watershed distribution. Consider CTA neck to assess
carotid arteries.
2. Intracranial arterial system is patent with no significant stenosis
or aneurysm.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, XXXX
11/05/2015 10:12
DOCUMENT STATUS: Final
POCT GLUCOSE - Final result (11/04/2015 9:00 PM CST)
Component Value Range
Glucose, POC 135 70-100 mg/dL
HEMOGLOBIN A1C - Final result (11/04/2015 7:33 PM CST)
Component Value Range
Hemoglobin A1C
5.4
Comment:
----
5.7-6.4%
Increased risk of diabetes.
----
Greater than 6.4%
Diagnostic of diabetes.
----
Less than 7%
Meets treatment goal of ADA.
----
Note change in reference range based on ADA guidelines.
0-5.7 %
Estimated Avg Gluc 108
Comment: The "Estimated Average Glucose" is an estimate of the patient's
glucose level over the last 60 days, based on the HgbA1c value.
mg/dL
LIPID PANEL - Final result (11/04/2015 7:33 PM CST)
Component Value Range
Cholesterol 167 0-200 mg/dL
Triglycerides 257 0-150 mg/dL
HDL 38 >50 mg/dL
LDL
78
Comment:
----
Classification:
< 100 mg/dL: Desirable LDL
100-129 mg/dL: Borderline LDL
130-159 mg/dL: Borderline High LDL
160-189 mg/dL: High Risk LDL
> 189 mg/dL: Very High Risk LDL
<100 mg/dL
VLDL 51 <30 mg/dL
Chol/HDL Ratio 4.4
Comment:
----
Classification:
<5.0 Goal
<3.0 Ideal
----
Highest acceptable and optimal values of cholesterol vary
with age. Values above 240 mg/dL are associated with
increased risk of coronary heart disease regardless of HDL
or LDL values.
----
Elevations of triglycerides can be seen with: (1) obesity
(2) medications (3) less than 12 hour fast (4) alcohol
intake (5) birth control medications.
----
Increased LDL cholesterol levels are associated with
increased coronary heart disease.
----
LDL/HDL ratio can be falsely elevated when patient has not
had a 12 hour fast prior to blood sampling.
----
The XXXXXXX Heart Association and the National Institute
of Health consider cholesterol levels below 200 mg/dL
desirable.
EKG VIEW FINAL - Final result (11/04/2015 7:28 PM CST)
Ct Head Or Brain Wo Contrast (CT HEAD OR BRAIN WO CONTRAST) - Final result (11/04/2015 2:54 PM CST)
Narrative
UNITYPOINT HEALTH - XXXX
RADIOLOGY TRANSCRIPTION REPORT
=======================================================================
PATIENT NAME: XXXX XXXXXXX L ACCOUNT#: 0000
MED REC #: 0000
DOB: XXXX
ORDERING PHY: XXXX
PERSONAL PHY: XXXX
SPECIALTY PHY: XXXX, XXXXXXX MD
PATIENT TYPE: ER ORDER # XXXX
PATIENT LOCAT: XXXX (EMERGENCY DEPARTMENT
EXAM DATE: 11/04/2015 1454
================================================================
Narrative
EXAM: CT HEAD WO CONTRAST
CT BRAIN WITHOUT CONTRAST
INDICATION: Headache and right upper shunt and weakness.
COMPARISON: None.
TECHNIQUE: Multiple axial images of the brain were performed without
intravenous contrast.
FINDINGS: There is no acute intracranial hemorrhage, mass effect or
midline shift. The gray-white matter differentiation is intact. There
are no acute extra-axial fluid collections. The ventricles and sulci
are normal. There is no effacement of the basal cisterns. No calvarial
fracture.
IMPRESSION: No acute intracranial process.
ELECTRONICALLY SIGNED BY: XXXXXXX XXXX. XXXX, DO
11/04/2015 15:03
DOCUMENT STATUS: Final
TROPONIN I - Final result (11/04/2015 2:30 PM CST)
Component Value Range
Troponin I
<0.01
Comment:
----
Normal Value <0.05
Indeterminate Range 0.05-0.77
Acute Myocardial Infarction >0.78
0-0.78 ng/mL
COMPREHENSIVE METABOLIC PANEL - Final result (11/04/2015 2:30 PM CST)
Component Value Range
Sodium 135 136-145 mmol/L
Potassium 3.8 3.6-5.1 mmol/L
Chloride 98 98-109 mmol/L
CO2 29 23-30 mmol/L
Glucose 291 70-99 mg/dL
BUN, Blood 15 6-22 mg/dL
Creatinine, Serum 0.84
Comment: The analysis was performed using an isotope dilution mass
spectrometry (IDMS) traceable methodology.
0.7-1.3 mg/dL
Calcium 10.2 8.8-10.3 mg/dL
Total Protein 7.2 6.4-8.0 g/dL
Albumin 4.0 3.5-4.8 g/dL
Total Bilirubin 0.8 0.4-1.3 mg/dL
Alkaline Phosphatase 91 25-105 U/L
AST 55 13-38 U/L
Anion Gap 12 8-20 mmol/L
ALT 40 0-40 U/L
GFR Estimate SEE NOTES
Comment:
>60
----
Greater than or equal to 60 mL/min/1.73 m2
The eGFR based on the MDRD Study equation is only useful
when renal function is stable and may not be suitable for
all populations.
This estimate is not recommended for patients with serious
co-morbid conditions, during pregnancy, older than 70 or
at the extremes of muscle mass or diet.
REFERENCE RANGES:
Chronic Kidney Disease - Less than 60 ml/min/1.73m2
Kidney Failure - Less than 15 ml/min/1.73m2
CBC (CBC (HEMOGRAM)) - Final result (11/04/2015 2:30 PM CST)
Component Value Range
WBC 7.63 4.00-11.00 th/mm3
RBC 4.62 4.20-5.20 mill/mm3
Hemoglobin 15.1 12.0-16.0 g/dL
Hematocrit 41.6 37.0-47.0 %
Component Value Range
MCV 90.0 81.0-98.0 fL
MCH 32.7 27.0-34.0 pg
MCHC 36.3 31.5-36.0 g/dL
Platelets 414 150-450 th/mm3
RDWSD 43.8 36.4-46.3 fL
RDW 13.3 9.0-14.5 %
MPV 9.7 8.7-12.6 fL
NRBC Absolute 0.00 0.0 th/mm3
NRBC % 0.0 0.0 %
ISTAT TROPONIN I - Final result (11/04/2015 2:29 PM CST)
Component Value Range
Troponin I, I-Stat 0.00 <0.08 ng/mL
EKG 12-LEAD - Final result (11/04/2015 2:19 PM CST)
Visit Diagnoses
Temporary loss of blood supply to brain - Primary
Admitting Diagnoses
Temporary loss of blood supply to brain
Administered Medications
Medication Ordered Dose Route Frequency Start Date End Date
nicotine (NICODERM CQ) 21 MG/24HR 1{patch} TD Daily 11/05/2015 11/06/2015
Insulin Aspart (NOVOLOG FLEXPEN)
injection - pen
1-5U SC 4 Times Daily AC and HS 11/04/2015 11/06/2015
clopidogrel (PLAVIX) tablet 75mg PO Daily 11/05/2015 11/06/2015
simvastatin (ZOCOR) tablet 20mg PO Nightly 11/04/2015 11/06/2015
senna-docusate 8.6-50 MG per tablet 1{tbl} PO BID 11/04/2015 11/06/2015
acetaminophen (TYLENOL) tablet 650mg PO Q6H PRN 11/04/2015 11/06/2015
enoxaparin sodium (LOVENOX)
injection 40 mg
40mg SC Q24H 11/04/2015 11/06/2015
nadolol (CORGARD) tablet 20mg PO Daily 11/05/2015 11/06/2015
multivitamin (THERA) tablet 1{each} PO Daily 11/05/2015 11/06/2015
insulin glargine (LANTUS SOLOSTAR)
injection - pen
52U SC Nightly 11/04/2015 11/06/2015
sodium chloride 0.9 % bolus 1,000 mL 1000mL IV Once 11/04/2015 11/04/2015
diphenhydrAMINE (BENADRYL)
injection
25mg IV Once 11/04/2015 11/04/2015
prochlorperazine (COMPAZINE)
injection
5mg IV Once 11/04/2015 11/04/2015
Document Information
Primary Care Provider
S XXXX (Sep. 30, 2013 - Present)
0000 (Zork)
0000 (Fax)
XXXX
Document Coverage Dates
Nov. 04, 2015 - Nov. 06, 2015
Custodian Organization
UnityPoint Health
XXXX
D XXXXXXX (Admitting)
0000 (Work)
0000 (Fax)
XXXX
Encounter Date
Nov. 04, 2015 - Nov. 06, 2015
Brief Answer:
Continue medications and physiotherapy and healthy life style
Detailed Answer:
Hello XXXX,
After evaluating all your reports and clinical condition I am suggesting you to continue all your medications as being advised with good control of diabetes, bl;good pressure and active healthy life.
The episode recently was a stroke and probably related to atherosclerotic plaque. No surgical intervention for carotid narrowing is required at present.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Continue medications and physiotherapy and healthy life style
Detailed Answer:
Hello XXXX,
After evaluating all your reports and clinical condition I am suggesting you to continue all your medications as being advised with good control of diabetes, bl;good pressure and active healthy life.
The episode recently was a stroke and probably related to atherosclerotic plaque. No surgical intervention for carotid narrowing is required at present.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Raju A.T
I am sorry to have sent such a mess as I had not intended for it to upload like that and it makes the actual question unable to be evaluated and answered. thank you for your attempt. I appreciate the effort.
Brief Answer:
Thanks for your appreciation
Detailed Answer:
Hello XXXX,
You are welcome at this forum with all your medical queries.
You can also put a direct query on my name when needed.
Regards
Dr Neeraj Kumar
Neurologist
Thanks for your appreciation
Detailed Answer:
Hello XXXX,
You are welcome at this forum with all your medical queries.
You can also put a direct query on my name when needed.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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