Notes

Assessments

1. Acute left monocular visual loss/left eye visual impairment, onset morning of admission, with stroke alert activated; NIHSS 0 and symptoms appear more consistent with ophthalmologic etiology, though retinal/arterial occlusive process could not be fully excluded initially.
2. CVA/TIA ruled out radiographically to date, with CT head and CTA head/neck without acute intracranial abnormality or large-vessel occlusion; MRI brain completed and per neurology review without acute ischemic stroke, official read pending/noted.
3. Hypertension.
4. Hyperlipidemia.
5. GERD.
6. BPH.
7. History of celiac disease.

Plans

1. Continue aspirin, loaded with 325 mg then 81 mg daily.
2. Start/continue high-intensity statin therapy with LDL goal <70.
3. Neurology consulted and recommendations appreciated; patient not a thrombolytic candidate as outside TNK window and no LVO target for intervention.
4. Complete stroke workup with MRI brain and echocardiogram if not already finalized; monitor on telemetry and follow neuro checks.
5. PT/OT/SLP evaluations as part of stroke protocol.
6. Ophthalmology evaluation/follow-up recommended given suspected primary ocular source of symptoms.
7. Blood pressure management: permissive hypertension during acute evaluation, then transition to long-term goal of normotension while avoiding significant BP fluctuations.
8. Check/track vascular risk stratification including A1c goal <6.5 and lipid optimization.
9. Continue GERD therapy with Nexium 40 mg daily.
10. Continue home BPH regimen.
11. DVT prophylaxis with heparin 5000 units subcutaneous every 8 hours while inpatient.