Benign stroke symptoms in the elderly population?

[Brekka, ADN, RN]

I am doing some research regarding benign stroke symptoms in the elderly, and thought it may not be a bad idea to stop here to see if anyone else has experienced this. I am still a new nurse, a few months away from my second year, and I work rehab and long term care.

So far in my year and a half of experience here I have seen this three times, all three in females over 60 years old. I don't want to provide a whole lot of information here that may put me or my patients at risk, so I'll give some basic information.

Present in each case:

• Female over 60
  
• Rehabilitation patient
  
• Independent wheelchair use, walking with therapy
  
• Social with others
  
• Alert and oriented x3
  

All three cases have a completely different diagnosis, and no similarities in medications or medical histories.

Case #1:

A rehab patient who is alert and oriented, independent and social. She wheeled herself all over the facility, loved to chat with anyone who would listen to her. She loved her therapy, and was progressing well. No difficulty talking or swallowing. She was like this when I left work on Friday, however when I returned on Monday I found a completely different person.

I found her disoriented, slumped over to her right side with general weakness, more noted on the right side. She had notable right sided facial drooping with excessive drooling noted. She was unable to respond to questions, and was slurring the words that she could make out. She wasn't able to follow commands, unable to swallow. No foreign object was present, vital signs were all well within normal limits for this patient, FSBS was 106. Apparently this had started on Saturday, but the weekend nurses didn't address it.

I sent her out immediately to the ER with the doctor's order with a diagnosis of a stroke. Two hours later she was sent back. All tests came back negative, not even a UTI was present. She has returned and improved slightly, but there is still a noted decline in cognition, strength and balance. Currently there's no known cause.

Case #2

Again we have a social, independent rehab patient who enjoys talking with care staff and other patients. She's alert and oriented, very active, and likes to know who's around and what's going on. Her family is in frequently talking with her, and she has an astounding memory and loves to share hers.

Again, she was perfectly normal when I left work the day before. When I come in the next morning, I'm notified that she's

acting strange.

I find her in her room with 4 briefs on, her shirt on her legs with one leg through one arm, and the other through the neck. She is topless and 'can't figure out how to get her second shirt on.'

All vital signs are within normal ranges, and are normal for her. She had difficulty speaking, difficulty following commands, and would just stare straight ahead with a blank expression on her face. When asked to squeeze with both hands at the same time, she would push with her left hand and pull slightly with her right. FSBS was just over 90 (don't remember the exact number).

The doctor was called and the resident sent out to the ER. She has a history of TIA's, and had her last one a month prior. She was sent back the same day without any diagnosis, no issues found. Like case #1, she has not improved much since this began.

Case #3

This patient is not mine, though I was the one that sent her while her nurse was out to lunch. Again we have an independent woman who is on her way out of the facility in a few days, and is using a walker for most of her day. She's alert and oriented, able to speak clearly and easily.

The nurse I was working with this day handed me over her keys while she took 20 minutes to get some food. In that time the resident reported that she felt as if her blood sugar was getting low and wanted it checked. I immediately checked it and found a FSBS of 231, which was normal for her PC. She stated, "Ok, I just feel a little weird." She then became completely unresponsive.

All vital signs were obtained and within normal healthy ranges, and were around her baseline. We had one of our patient physicians/medical director was there as well.He assessed the resident and found her unresponsive to any stimuli. He said to call an ambulance, she's having a stroke.

Ambulance responded, and she continued to be completely unresponsive. Pupils were pinpoint and sluggish to react. She went right out to the ER, and came back within hours. They didn't find anything wrong.

Now all three of these patients have gone for multiple CT scans, had MRI's, UA's and a variety of other repeated tests. To this day all three of these are unexplained. Not even their physicians have an explanation.

No, I am not a student asking for homework help. I'm just curious to see if anyone has seen this, and if so, have you found a possible cause?