Clinical Reasoning: An 87-year-old woman with left-sided numbness.

Content Provider	Semantic Scholar
Author	Yaghi, Shadi Elkind, Mitchell S. V.
Copyright Year	2015
Abstract	An 87-year-old woman with a history of hypertension, hyperlipidemia, and peripheral vascular disease presented with acute left paresthesias. On evaluation, blood pressure was 152/77 mm Hg and heart rate 78 and regular. Physical examination had normal results. On neurologic examination, she had normal mental status, decreased sensation on the left face, and normal strength, tone, and reflexes. Cerebellar examination and gait were normal. There was reduced light touch and pinprick sensation of the left arm and leg, with no extinction. Complete blood count and comprehensive metabolic panel were within normal limits, and ECG showed normal sinus rhythm. Head CT scan was unremarkable. She was prescribed aspirin and admitted for evaluation. Symptoms lasted 48 hours. Brain MRI showed no acute infarction. Magnetic resonance angiography showed normal intracranial vessels and mild bilateral internal carotid disease. Echocardiography showed an ejection fraction of 55%–60% and no structural abnormalities, though the left atrium was not visualized. On telemetry, she had 2 self-limited episodes of asymptomatic paroxysmal supraventricular tachycardia. She started a low dose β-blocker.
Starting Page	57
Ending Page	76
Page Count	20
File Format	PDF HTM / HTML
DOI	10.1212/WNL.0000000000002022
PubMed reference number	26459945
Journal	Medline
Volume Number	85
Issue Number	15
Alternate Webpage(s)	http://www.neurology.org/content/85/15/e110.full.pdf
Alternate Webpage(s)	https://doi.org/10.1212/WNL.0000000000002022
Journal	Neurology
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article