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Case 02 — frailty and baseline dependency
Constructed teaching vignette retained from the source case. Actions described are scenario facts, not recommendations.
Got a tough one in bay six. 91-year-old male, sudden left-sided weakness witnessed by care home staff 3 hours ago. Baseline is poor, advanced vascular dementia, mRS 4, needs assist of two for all transfers. Current NIHSS is 18, completely neglected on the left, eyes turned to the right. Non-contrast CT shows loss of insular ribbon on the right. CTA shows a right M1 occlusion. Thrombolysis was withheld given his advanced baseline dependency and family preferences. The family is here now and wants to understand what else can be done for him.
The decision to examine
What information was available at this decision point? Which options were considered? What evidence is missing, and which preferences need clarification? This scenario does not supply a definitive answer.