I had my first stroke patient last week. It was a great learning experience, but also a reminder of how amazing the mind is. Mr. H presented with sudden onset of right sided weakness and word-finding difficulties. His left internal carotid artery was complete occluded. By the time he reached the emergency department, his weakness and word-finding had already improved, but not completely. Then on Hospital Day 2, when I saw him in the morning, his weakness and word-finding had worsened compared to how he was when I met him in the ED. What do I do?! What can be done?! What does this mean?! He went from responding to my questions immediately but with difficulty finding certain words to not being able to say "hello" after picking up the phone.

Turns out there was not much to be done. Even the neurologist kind of just took a shot in the dark by saying he needed ICU care for more frequent nursing checks. Luckily, he improved again and returned to how he was when I met him in the ED. Rehab is the only treatment for him now.

The internal carotid artery is a huge artery to the brain. This patient had managed to form collateral blood vessels over time to still supply enough blood to his brain even with the ICA being completely occluded to only have some R-sided weakness and word-finding difficulties. His life is going to be harder, but not as tragic as it could be with that type of occlusion.