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Stroke Onset Date / Time / Discharge Date
Dr. Faculty Discharge Note
Resident / Intern PMD
Discussion of Hospital Stay:
Diagnosis (Check all that Apply) Diagnostic Procedure Results
! TIA ! Stroke Syndrome without Infarct ! CT : Results: ! Hemorrhage ! Ischemic infarction
! Ischemic Stroke with Infarction ! SAH ! TEE Results:
! Cerebral Hemorrhage ! Negative.
Mechanism of Stroke ! Positive for intra- atrial clot.
! Small Vessel Occlusive ! Cardioembolic ! Positive for patent foramen ovale.
! Large Vessel Atherosclerotic ! Tandem Lesion Stroke ! Positive for left atrial enlargement.
! Vasculitis (Artery to Artery embolus) ! Other:
! TTE Results:
! Hypercoagulable State (specify defect) !Negative.
! Positive L Ventricular Hyperrtrophy
! Other identified cause (specify) !Positive intra-ventricular clot.
! Other:
! Cryptogenic (unidentified cause) Ejection Fraction: ! 0-40% ! 41-60% ! >60%
! Hemorrhagic Transformation of Ischemic Stroke ! MRI: Results: ! Normal ! New Infarct
! Hypertensive Hemorrhage ! Lobar Hemorrhage ! Non localizing microvascular disease ! Other
! Ruptured Aneurysm ! Ruptured AVM ! MRA: Results: ! Normal ! Intracranial stenosis ! Other
Clinical Manifestations ! LP
Presenting Symptoms Discharge Day Exam ! Carotid Duplex Results:
! Aphasia ! Ataxia ! Dysarthria ! Aphasia ! Ataxia ! Dysarthria ! Negative.
! Dysphagia ! Numbness/Tingling ! Dysphagia ! Numbness/Tingling ! R Carotid Stenosis >50%. ! L Carotid Stenosis >50%.
! Weakness(face,arm, leg) ! Weakness(face,arm, leg) ! ANGIOGRAM: Results
! Visual loss ! Others: ! Visual loss ! Others: ! EKG rhythm: ! NSR ! Afib ! Other
! LABS: Total Cholesterol LDL
Location of NEW INFARCTS
! Cerebral Cortex: ! Subcortical Areas Homocysteine level
! Left hemisphere ! Subcortical white matter Coag. Studies
! Right hemisphere ! Internal capsule
! Frontal Lobe ! Basal ganglia Others:
! Parietal Lobe ! ACA ! Thalamus ! Other Tests:
! Occipital Lobe ! PCA ! Brainstem
! Temporal Lobe ! MCA ! Cerebellum (VB) Stroke Treatment/ Prevention
! Spinal Cord Acute Therapy
! Unknown ! Fibrinolysis IV IA
Total Time Spent Coordinating Care: min ! Stroke Team Consult (specify reason)
! Discharge prescriptions and/or referral forms given
! Stroke Study Enrollment (specify which study)
Patient Instructions Prevention Therapy
Pre-admission Discharge
! Aspirin (dose____mg) ! Aspirin(dose__mg)
! Dipyridamole ! Dipyridamole
! Hospital course reviewed with patient, see discharge summary ! Warfarin ! BP Meds ! Warfarin ! BP Meds
! Ticlopidine ! Ticlopidine Modified
Follow-up Appointment: (check below) ! Clopidogrel ! Clopidogrel
! In NV resident clinic with Dr in wks ! C. Endarterectomy ! C. Endarterectomy
! Cholesterol Lowering Agent ! Cholesterol Lowering Agent
! With Dr in Thursday mult-discliplinary NV ! No therapy ! No therapy
clinic in wks ! RISK FACTORS IDENTIFIED AND MODIFIED:
! Hypertension ! Diabetes ! Hyperlipidemia ! Smoking
! With Dr in Neurology clinic in wks ! ETOH ! A-fib prior CVA/TIA ! PFO/ASD ! Migraines
! PVD ! CHF ! CAD
! In wks with next available stroke faculty
Other:
Staff Signature NIH Stroke Scale- Admission Score:
Date/Time
NIH Stroke Scale- Discharge Score:
Resident Signature Rankin Admission ! 1 ! 2 ! 3 !4 !5
Date/Time
Rankin Discharge ! 1 ! 2 ! 3 !4 !5
Diag Sum Isch Stroke
9200 West Wisconsin Avenue
ORIGINAL - Medical Records P.O. Box 26099
Discharge Day Management 3746 CANARY - Nursing Milwaukee, WI 53226-3596
3746 Primary Affiliate of the
Summary For Neurovascular Patients - Item # 3746 5/04 Medical College of Wisconsin
SAME AS 1
