This 63 year old right-handed
male was well until early on the morning of admission, when he had a 5 minute
spell of tingling in the right cheek, followed by inability to speak. He
remained alert and had intact memory of the events.
He was able to communicate
with hand gestures, but noted during transport to the hospital that his right hand
was not functioning properly. He could not write with either the right or the
left hand. His speech returned during transport to the hospital, less than 60
minutes after the episode's onset.
There was a history of
Micronase-treated adult onset diabetes mellitus, and a 5 year history of
arterial hypertension, treated with Vasotec.
He was alert and oriented, with
paucity of speech, and some hesitation in word-finding. He had a mild right
hemiparesis, affecting triceps and wrist extensors. Serum glucose was 166, but
all other blood chemistry and hematology was normal.
EKG showed evidence of
left ventricular hypertrophy and a 24 hour Holter monitor was normal. Chest
x-ray was normal except for a tortuous aorta. MRA was normal. Myocardial
infarction was ruled out. He was started on intravenous heparin, then converted
to warfarin. Over the next 7 days, the deficits slowly resolved.
