This is a 83 year-old woman who presents to the ER by medics from her
nursing home. She was watching TV when she had sudden onset of HA, increased
confusion, and right leg weakness. No vision change, aphasia, or vertigo.
At baseline she has trouble walking and moderate dementia. No previous
similar events. Over the last 1 hour she has worsened slightly. Coumadin
recently increased for a nontherapeutic INR.
2. ASCVD s/p MI 1999
3. DVT right leg 3 months ago
4. Hysterectomy 1974
6. Alzheimer's dementia
1. Lisinopril 20mg qd
2. Coumadin 5mg qd
3. Furosemide 20mg bid
4. KCl 10meq qd
5. Quinine hs prn
6. Aricept 10mg qd
Family History: Positive for ASCVD and diabetes mellitus.
Father died of an MI at 72. Mother died of breast cancer at 79.
Social History: No smoking. No alcohol. Lives in nursing
home. Widowed. No children.
BP 190/98 HR 92 (regular)
General: Agitated elderly female. Carotid auscultation
Mental Status: Does not follow all complex commands.
Fluent. Oriented to place and self only.
HEENT: PERRLA. EOMI. Visual fields full. Face normal.
OP benign. Tongue midline.
Motor (Power/Tone/Bulk): Left 4+/5 consistent with age.
Right arm 4+/5. Right leg 2/5.
Sensory: Reduced light touch in the right leg.
Reflexes: 1/4 at the biceps, triceps bilaterally. Right
knee and ankle 3/4. Left knee and ankle 2/4. Right toe upgoing, left toe
downgoing to plantar stimulation.
Coordination: FNF normal. Can't test right HKS.
Gait: Can't test.
Abnormal Movements: None
Other Organ: 2/6 systolic murmur heard at the ULSB without
radiation. The right calf is swollen. JVD 8cm. Lungs reveal bibasilar
Abnormal. Normal rate of 82. Sinus rhythm. Q-waves in II, III and AVF
indicative of an old inferior MI.