Neurology Clerkships
Case 3  
Author: Eric Kraus, MD
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This is a 69 year-old woman who presents to the ER by medics. She woke up and couldn't get out of bed. Her husband helped her into a chair. He noticed dysarthria, right facial droop and right sided weakness. No sensory loss, vision change, cognitive deficit, aphasia, or vertigo. Because they live in the country, 4 hours has elapsed since she woke up. Prior to this she has been feeling fine. No previous similar events. In the last 4 hours she has improved slightly.

1. HTN
2. ASCVD s/p MI 1999
4. Hysterectomy 1974
5. Hyperlipidemia

1. Lisinopril 20mg qd
2. ASA 81mg qd
3. Metoprolol 100mg qd
4. Pravastatin 10mg qd
5. Quinine hs prn

Allergies: NKDA

Family History: Positive for ASCVD and diabetes mellitus. Father died of an MI at 72. Mother died of breast cancer at 79.

Social History: Quit smoking 1984 (35 pack years). No alcohol. Lives with husband. Likes to garden.

BP 180/108   HR 88 (regular)   T 37.0°C
General: Calm elderly female. Carotid auscultation normal.
Mental Status: Dysarthric. Comprehension and fluency intact. Alert and Ox3.
HEENT: PERRLA. EOMI. Visual fields full. Right facial droop sparing the forehead. OP benign. Tongue midline.
Motor (Power/Tone/Bulk): Left 5/5. Right side 3/5 throughout except knee flexion/extension, biceps, and grip all 4/5.
Sensory: Intact to vibration and light touch.
Reflexes: 1/4 at the biceps, triceps, knee, and ankle bilaterally. Right toe upgoing, left toe downgoing to plantar stimulation.
Coordination: Can't test on right due to weakness. Left side FNF normal.
Gait: Can't test.
Abnormal Movements: None
OtherOrgans: 2/6 systolic murmur heard at the ULSB without radiation.

EKG: Abnormal. Normal rate of 82. Sinus rhythm. Q-waves in II, III and AVF indicative of an old inferior MI.

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