Case 17

Clinical history and examination

Age: 69 years, Female.
Time of presentation: 18:00

History of event

• Symptoms: fluctuating aphasia and right sided weakness
• Current time interval since last known well: symptoms have been fluctuating, at best just hesitancy of speech but at worst severe aphasia and unable to keep arm and leg off bed during NIHSS. Last was normal 5 hrs (300 mins) ago, but for last hour has only mild aphasia.

Past medical history

• Previous MI
• Hypertension

Relevant medications

• Aspirin
• Amlodipine
• statin

Relevant social history

• Living circumstance: home alone
• Prior function and care needs: normally independent
• Work/hobbies: retired teacher, reading

Examination

• Pulse: 77, BP: 190/86
• Neuro:
  • Handedness: right handed
  • NIHSS: 1 (currently) , but 11 then 14 when at worst
  • Deficits: currently mild aphasia,  reduced fine finger movement in right hand

Investigations requested with non imaging results