Case 14

Clinical history and examination

Age: 70 years, Male.
Time of presentation: 18.45

History of event

• Symptoms: intermittent vertigo for a few hours, then double vision and an hour later left face, arm and leg weakness, severe slurred speech
• Current time interval since last known well: 12 hours since first vertigo, but 4 hrs 20 mins (260 mins) since diplopia and 3 hrs 20 mins (200 mins) since weakness

Past medical history

• Hypertension
• Type 2 Diabetes

Relevant medications

• Aspirin
• Enalapril

Relevant social history

• Living circumstance: home with partner
• Prior function and care needs: independent
• Work/hobbies: retired, seniors tennis

Examination

• Pulse: 110 irreg, BP: 190/100
• Neuro:
  • Handedness: right handed
  • NIHSS: 13
  • Deficits: marked dysathria, dysconjugate eye movements, nystagmus, left face, arm and leg weak, unable to sit

Investigations requested with non imaging results

• ECG: fast AF