The severe stroke — basilar artery, day 3
| Patient | 72M, acute phase |
|---|---|
| Lesionbrainstem territory, severe | |
| Severity | NIHSS 24 |
| Days since onset | 3 |
| Before the strokeIndependent; keen gardener, widower, lives with son. | |
| Also on the chartHypertension; Previous TIA | |
| PrecautionsNG feeding — nothing by mouth; Weak cough — secretion clearance every session; Full head support for all sitting | |
Test yourself
What does the first PT session on this stepdown address?
The teaching
The basilar case re-teaches what “mobilization” means: at this severity it is measured minutes of supported sitting, secretion and swallow management, and positioning that keeps the contracture window from closing. The communication task is the mirror image of the clinical one — replace the family’s milestone (walking) with the week’s real ones, in words they can watch for.
- Desaturation, new drowsiness, secretion retention — stop and escalate
- Skin over the sacrum and heels checked every positioning change
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Winstein CJ et al. Stroke. 2016 · AVERT Trial Collaboration group. Lancet. 2015. Winstein CJ et al. Stroke. 2016