Case studyCardiovascular disease

Hypertension and Hypercholesterolemia Patient Case

Two events in this history predicted the stroke, and one detail about when he woke up decides what can be done about it. Both are easy to read past.

Editorial process

Last reviewed · August 25, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Wake-up onset, and two warnings nobody acted on

Two details decide this case. The first is the timing: he was well at 11pm and found symptomatic at 5am, so the last known well time is 11pm rather than 5am, and that single fact governs which acute treatments are available since eligibility windows run from when he was last known well. Say this explicitly, because the instinct is to date the stroke from when it was noticed. The second is the history: amaurosis fugax in the right eye a month ago is transient monocular blindness from the ophthalmic artery, a branch of the right internal carotid, and it points directly at the vessel supplying the territory that is now infarcted. That is not incidental history, it is a warning that was missed, and carotid imaging is where the workup is heading. The workup is heading toward carotid imaging, and saying so early shows the history has been read rather than recited.

Localise before you speculate. Left arm and leg weakness with slurred speech in a right-handed man, together with an inability to turn the eyes voluntarily toward the left, indicates a right hemispheric lesion, since gaze deviates toward the side of the lesion and the eyes look away from the weak side. Language is likely to be preserved because the dominant hemisphere is spared, which is why the speech disturbance is dysarthria rather than aphasia, and that distinction matters clinically. The leg claudication three months ago completes the picture of widespread atherosclerotic disease across coronary, carotid and peripheral beds in a man already on aspirin, an ACE inhibitor and a statin, which raises the question of whether he was actually taking them. His blood pressure of 195 over 118 also needs careful handling, because the thresholds for lowering it differ depending on whether thrombolysis is being considered.

Likely learning objectives

Establish last known well time rather than time of discovery.
Read amaurosis fugax as territory-specific warning of carotid disease.
Localise the lesion from gaze deviation and the side of weakness.
Distinguish dysarthria from aphasia and say why it matters.

Assignment instructions

Read the full question

Review every instruction before using the planning guidance that follows.

A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50. He currently is unable to move his left arm and leg. He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes. Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes. He is taking a baby aspirin a day an ACE inhibitor, and statin as well. He does have a history of alcohol use and smoking in the past but stopped after his heart attack. His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, o2 sat is 97% on room air. Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side. The neck is supple, there is no jugular vein distension, and there are no bruits. The lungs are clear heart sounds regular without murmurs, and abdomen is normal. The limbs are not well perfused distally. The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick. He shows loss of awareness and attention with respect to objects or stimuli on his left side. He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well. There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation. He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing. What are two questions you would ask this patient? Identify the subjective data for this patient. Identify the objective data for this patient. What is the likely diagnosis? Your response should include evidence of review of the course material, websites, and literature through proper citations using APA format. Hypertension and Hypercholesterolemia Patient Case

What the case asks

01An assessment of this patient's presentation and history.
02Localisation of the lesion from the neurological findings.
03Identification of the likely mechanism and the vascular territory involved.
04Immediate priorities and investigations.
05Consideration of blood pressure management in the acute setting.
06Secondary prevention and the significance of the preceding events.