The patient was discharged home on the second hospital day.įour days after discharge, and 7 weeks before the current admission, the patient presented to the other hospital with transient mild aphasia. Treatment with aspirin was continued, clopidogrel was discontinued, and apixaban was started previously prescribed antihypertensive therapy with amlodipine and lisinopril was resumed. There was also a small focus of remote petechial hemorrhage in the subcortical white matter of the left parietal lobe.Īlthough continuous telemetry revealed no evidence of atrial fibrillation, the patient’s strokes were thought to be cardioembolic, resulting from atrial fibrillation. Magnetic resonance imaging (MRI) of the head, performed without the administration of intravenous contrast material, revealed a few small foci of acute infarction involving the frontal lobes, the posterior limb of the right internal capsule, and the right middle cerebellar peduncle. The patient was admitted to the hospital, and the aphasia resolved on the second hospital day. Treatment with aspirin and clopidogrel was initiated. CT angiography of the head and neck revealed calcified atherosclerosis along the arch of the aorta, the origin of the left vertebral artery, the intracranial portion of the left vertebral artery, the carotid bifurcations, and the cavernous portions of both internal carotid arteries there was no hemodynamically significant stenosis. The score of 3 was due to partial loss of the right visual field and mild-to-moderate aphasia and dysarthria.Ĭomputed tomography (CT) of the head, performed without the administration of intravenous contrast material, revealed no abnormalities. His score on the National Institutes of Health Stroke Scale was 3, with scores ranging from 0 to 42 and higher scores indicating greater severity. Seven and a half weeks before the current admission, the patient presented to another hospital with aphasia. He had taken warfarin for many years but had stopped taking it 10 years before this admission. A myocardial infarction had occurred 18 years before the current admission atrial fibrillation had also been diagnosed at that time. The patient had a history of hypertension and coronary artery disease. Silverman: A 68-year-old man was admitted to this hospital because of worsening confusion. The most trusted, influential source of new medical knowledge and clinical best practices in the world.ĭr. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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