Stroke on Paul Nystrom

When You're a Hammer, Everything Looks Like a Nail

Sat, 14 Mar 2026 00:00:00 +0000

Hypertension (HTN) in the ER is one of the least interesting things we deal with. Through many discussions with colleagues, this is a fairly universal sentiment among ER doctors. There are very few conditions in which we need to immediately lower a patient’s blood pressure. Aortic dissections, hypertensive emergencies, acute strokes, acute coronary syndrome, and preeclampsia are about the only ones that come to mind. These are referred to as “end-organ damage,” i.e., the HTN is actually causing an acute issue damaging the brain, heart, or kidneys, and it needs correcting.

Strokes and Old Strokes

Sat, 10 Jan 2026 00:00:00 +0000

Most people have some vague idea of what a stroke is. There has been a significant education campaign by the American Heart Association so that people can recognize a stroke quickly, call 911, and get to the ER for appropriate care. Common symptoms include inability to speak, slurred speech, facial droop, and weakness on one side of the body.

Strokes generally come in two varieties. The most common type is referred to as an ischemic stroke, which is caused by clotting of a blood vessel in the brain. This leads to damage downstream from the blockage because that area is deprived of blood flow—and specifically oxygen. The other type of stroke, which is much rarer, results from the rupture of a blood vessel in the brain. These are referred to as hemorrhagic strokes.

Highly Sensitive People

Sun, 07 Dec 2025 00:00:00 +0000

People with neurologic symptoms that require an excessive number of terms to describe them are not having a stroke. Patients who are actually having a stroke most often have one extremity that simply doesn’t work. It is functionally weak, paralyzed, or flaccid—it simply does not move. Speech is slurred, and the face often droops, most noticeably at the corner of the mouth.

I had a patient last night with a history of migraine headaches. With this particular headache, she complained of pain that radiated down her neck into her right arm and hand. She described her hand as “hot” and provided an excessive number of additional descriptors for her arm: tingling, “not there,” fuzzy, warm. I’ve heard other patients use similar terms like “off” or “buzzing.”

Jailbreak

Sun, 07 Dec 2025 00:00:00 +0000

I have a friend whose dad has been in the hospital for 10 days because of high blood pressure. Nothing the doctors have tried seems to fix it. He’s on multiple medications with very little progress. The prolonged hospital stay has drained his motivation; he’s clearly more depressed than he was. They’ve accomplished very little, and there’s been almost no communication with the family about what the end goal even is. His blood pressure is still running high, so not much has really been accomplished.