Ø 76 year old man, slightly confused
Ø Wife describes symptoms starting 30 minutes ago
Ø Sudden onset of difficulty getting his mouth to form words; speech is slurred
Ø Face and mouth numb; tongue feels ‘thick’
Ø Unable to hold his coffee cup in his right hand
Ø Right leg weak; needs to hold on to the table to stand
Question 1: What is your differential diagnosis based on the information you have now?
Question 2: What other questions would you like to ask?
Ø History of essential hypertension
Ø Has not been taking his thiazide diuretic because it makes him feel ‘bad’
Ø Was told he has high cholesterol but has not returned to see his primary care provider
Ø Has experienced several brief spells of right-sided weakness which resolved in a few minutes; thought this was his arm falling asleep
Ø No head trauma or recent infections
Ø Family history; mother died of stroke, father died of acute myocardial infarction (AMI)
Ø Smokes 1 pack/day of cigarettes for the past 30 years
Ø Sedentary lifestyle
Question 3: Now what do you think?