Download MGR Case Report - Clinical Correlations

Clinical Correlations
The NYU Internal Medicine Blog
A Daily Dose of Medicine
http://clinicalcorrelations.org
Medical Grand Rounds
Clinical Vignette
October 22, 2008
By:
Yelena Kopyltsova, M.D.
Medicine-Surgery Conference
Thursday, October 30th, at 5pm
Surgery in Patients With Coronary Stents
Speakers:
Dr. William Slater
Department of Cardiology
Dr. Joseph Carter
Department of Surgery
Farber Auditorium (Bellevue Atrium)
Food will be served
Chief Complaint
61 year-old man presents with right hand
weakness, right facial numbness and
dysarthria for 15 minutes
History of Present Illness
The patient was in his usual state of good health until 2
days ago, when he noted garbled speech, blurry vision,
right facial numbness, and right hand weakness that
lasted around 8 minutes. Patient felt completely normal
after and disregarded the symptoms.
On the morning of presentation, he started to experience
the same symptoms as two days earlier, but this time
they persisted for 15 minutes. Although he was
asymptomatic afterwards, his family urged him to come
to the ED for evaluation.
Additional History
PMH:
Hypertension
Hyperlipidemia
PSH:
None
Soc. Hx: 15 pack-year tobacco history
1 glass of wine daily
No illicit drug use
Fam. Hx: Father deceased at 67 from MI
Mother deceased from unknown causes
Allergies: NKDA
Meds: Self-discontinued all meds 1 year ago
Physical Exam
GENERAL: Caucasian man in no acute distress
VS: BP 147/82 mmHg, HR 87 bpm, RR 14/min,
O2 saturation 98% on room air
The remainder of the physical exam was normal
Laboratory Findings
WBC: 6.3
Hemoglobin: 14
Platelet count: 258
Coagulation studies: within normal limits
Lipids: HLD 35, LDL 156, Triglycerides 320
Glucose: 102
Electrolytes: within normal limits
Additional Data
EKG: sinus rhythm with left ventricular
hypertrophy, but no ST or T-wave changes
CXR: no consolidations, effusions or
pneumothorax
Normal Non-Contrast Head CT
Preliminary Diagnosis
Transient ischemic attack
Hospital Course
The patient was started on aspirin and
admitted for observation and expedited
workup
He had a 2-D echo with bubble contrast
and carotid ultrasound, both of which were
normal.
He had no dysrhythmias on his cardiac
monitor.
MRI of brain revealed mild to moderate
microvascular disease
Further Work-up
MRI with microvascular disease
Follow-up
Patient was discharged home on a
thiazide diuretic, statin, and aspirin
His follow up is with neurology clinic
He was counseled on benefits of smoking
cessation
At two months, the patient did not have
any residual deficits and was compliant
with medications
Final Diagnosis
Transient ischemic attack due to small
vessel disease