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Lombardo Palma, MD, MSPH
West Jordan, Utah

JAMA. 1997;278(13):1060-1061.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—A recent Clinical Crossroads¹ began with the case of Mrs X's recovery from a severe ischemic stroke, probably due to thromboembolic phenomena generated by severe mitral stenosis. Although Dr Alexander, the discussant, presented the case differently, after detailed reading I am recounting the case as follows. The patient was treated with recombinant tissue-type plasminogen activator (rt-PA) within the Food and Drug Administration's (FDA's) approved time window. I assume her coagulation test results were normal before administration of thrombolytic therapy, although those findings were not given.

The patient's condition deteriorated over the next 2 days; she became drowsy and lethargic. Despite this clinical observation, I am surprised that no standardized stroke scales were used to document this change objectively. A time plot of the values of a neurologic deficit stroke scale would have made this neurologic decline evident. Additionally, this would have suggested the need to repeat the . . . [Full Text PDF of this Article]

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