CASE HISTORY - CASE 2

Presentation

A 49 year old man was taken to casualty with paralysis of the left leg. He had a six-month history of TIAs of increasing frequency. A carotid bruit was heard in casualty. However, before he could be admitted he collapsed and was transferred to ITU where his condition deteriorated rapidly and he died early the next day.

History

The man was an ex-smoker and drank an average of 4 pints of beer three times a week. Since suffering his first TIA six months previously, he had tried to cut down and had taken to swimming once a week. The symptoms of his first TIA included dysarthria and transient left-sided anaesthesia. Four months later he suffered another TIA, and then suffered two more in the next two months. A stressful job situation and problems at home caused him to carry on drinking. He says he was not worried about his own health as there were "other things to worry about." He also put his daily headaches down to the stress.

The final TIA brought him to casualty as it occurred on a Saturday afternoon when it was difficult for him to see his GP.

Examination

In Casualty:

Test Results in ITU: Progression

His sudden collapse caused him to be rushed to ITU. He became increasingly unresponsive and started to convulse throughout the night. He went into respiratory failure early in the morning, and subsequently passed away.