Case 11

Clinical history and examination

Age: 74 years, Male.
Time of presentation: 23:00

History of event

• Symptoms: witnessed acute onset of right sided weakness, then a few minutes later had tonic clonic seizure which self terminated.
• Current time interval since last known well: 3 hrs (180 mins)

Past medical history

• Excess alcohol
• Previous seizure 5 years ago
• Cirrhosis with varices (no bleeding)

Relevant medications

• Thiamine
• Folic acid
• Propranolol
• No anticonvulsants

Relevant social history

• Living circumstance: home with partner
• Prior function and care needs: independent
• Work/hobbies: retired publican, non driver

Examination

• Pulse: 92 reg, BP: 167/83
• Neuro:
  • Handedness: right handed
  • NIHSS:  13
  • Deficits: drowsy, weakness of right face, arm and leg, not speaking or following commands

Investigations requested with non imaging results

• INR 1.4
• Normal blood count