Case 19

Clinical history and examination

Age: 76 years, Male.
Time of presentation: 10.00

History of event

• Symptoms: in hospital for last 10 days receiving iv antibiotics for staph aureus endocarditis confirmed on blood cultures and echocardiogram. Develops sudden speech disturbance and  severe weakness of right arm
• Current time interval since last known well: 30 mins

Past medical history

• Diabetes
• Known aortic stenosis
• Recent cellulitis of left leg

Relevant medications

• iv antibiotics based on sensitivities from blood cultures

Relevant social history

• Living circumstance: home with brother
• Prior function and care needs: previously independent
• Work/hobbies: retired builder, horse racing

Examination

• Pulse: 100,  BP 134/86
• Neuro:
  • Handedness: right handed
  • NIHSS: 15
  • Deficits: severe aphasia, right face weak, right hemiparesis

Investigations requested with non imaging results

• BM: 15mmol/l