Category: Advancing Modules

Case 14

Case 14 CT Angiogram

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

Case 13

Case 13 CT Angiogram

Clinical history and examination

Age: 84 years, Female.
Time of presentation: 12 noon

History of event

  • Symptoms: fell, fractured right neck of femur, found to have right sided weakness
  • Current time interval since last known well: 2 hrs 45 mins (165 mins)

Past medical history

  • Osteo arthritis
  • COPD

Relevant medications

  • Inhalers
  • Analgesics

Relevant social history

  • Living circumstance: home alone
  • Prior function and care needs: independent, walks with stick outside
  • Work/hobbies: retired, knitting, volunteer in cafe

Examination

  • Pulse: 70, BP 166/88
  • Neuro:
    • Handedness: right handed
    • NIHSS: 8
    • Deficits: right facial droop, moderate weakness right arm and leg, no hand function, sensory loss on right

Investigations requested with non imaging results

  • None