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Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine

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

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Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine

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  1. Clinical Correlations The NYU Internal Medicine BlogA Daily Dose of Medicine http://clinicalcorrelations.org

  2. Medical Grand RoundsClinical VignetteOctober 22, 2008 By: Yelena Kopyltsova, M.D.

  3. 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

  4. Chief Complaint • 61 year-old man presents with right hand weakness, right facial numbness and dysarthriafor 15 minutes

  5. 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.

  6. Additional History • PMH: • PSH: • Soc. Hx: • Fam. Hx: • Allergies: • Meds: Hypertension Hyperlipidemia None 15 pack-year tobacco history 1 glass of wine daily No illicit drug use Father deceased at 67 from MI Mother deceased from unknown causes NKDA Self-discontinued all meds 1 year ago

  7. 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

  8. 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

  9. Additional Data • EKG: sinus rhythm with left ventricular hypertrophy, but no ST or T-wave changes • CXR: no consolidations, effusions or pneumothorax

  10. Normal Non-Contrast Head CT

  11. Preliminary Diagnosis • Transient ischemic attack

  12. 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

  13. Further Work-up • MRI with microvascular disease

  14. 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

  15. Final Diagnosis • Transient ischemic attack due to small vessel disease

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