Case 09

Clinical history and examination

Age: 63 years, Male.
Time of presentation: 19:00

History of event

• Symptoms: Loss of vision to left, mild weakness in left arm and leg
• Current time interval since last known well: 4 hrs (240 mins)

Past medical history

• Prosthetic mitral valve
• AF
• had GI bleed 5 years ago when INR >5
• No recent GI symptoms

Relevant medications

• Warfarin
• Bisoprolol
• Furosemide

Relevant social history

• Living circumstance: at home with partner
• Prior function and care needs: independent and active
• Work/hobbies: company director, driver, keen golfer

Examination

• Pulse: 66 irreg, BP: 155/80
• Neuro:
  • Handedness: right handed
  • NIHSS:  6
  • Deficits: left hemianopia, drift left arm and leg, mild sensory loss on left, sensory inattention

Investigations requested with non imaging results

• ECG: AF
• FBC normal
• INR 1.7