Chapter

Case 4

Sarah Pendlebury, Ursula Schulz, Aneil Malhotra and Peter M. Rothwell

in Oxford Case Histories in TIA and Stroke

Published on behalf of Oxford University Press

Published in print January 2012 | ISBN: 9780199539345
Published online November 2012 | e-ISBN: 9780191753251 | DOI: http://dx.doi.org/10.1093/med/9780199539345.003.0040

Series: Oxford Case Histories

Case 4

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A 74-year-old woman presented to the medical take with confusion that appeared to have come on gradually over a few days. There was a past history of hypertension and she was taking bendroflumethiazide. She had otherwise been fit and well. On examination, she was drowsy and unable to answer questions or follow commands. Her cheeks appeared flushed. She was apyrexial with an irregular pulse of 100bpm and blood pressure of 110/70mmHg. There were no splinter haemorrhages. Examination of the cardiovascular system showed a grossly displaced apex, loud pansystolic murmur, low-pitched diastolic murmur, and a loud first heart sound. The jugular venous pressure (JVP) was raised 6cm with evidence of systolic (CV) waves, and there was mild ankle swelling. Cranial nerves (CN) appeared intact, fundi were normal, and examination of the limbs showed increased tone on the right and an extensor right plantar response. There was multifocal myoclonus.

Chapter.  1305 words.  Illustrated.

Subjects: Neurology

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