Michael Smith, a 68 year old man, is brought into the ED by ambulance after developing sudden onset right-sided weakness this morning with associated headache and confusion.
On arrival to hospital he has a dense right-sided hemiplegia and appears dysphasic and confused. There does not appear to be any history of fall or head strike.
List some possible differential diagnoses for this presentation
Are there any key aspects to Michael’s medical history that are important in confirming the differential and ongoing management?
Time course of symptoms: time of initial onset (or when last seen normal)
Initial symptoms and progression
Was there a seizure?
Think of risk factors:
History of hypertension
Any known vascular malformations?
Smoking history
History of malignancy (ICH into metastasis)
Dementia (risk of amyloid angiopathy)
Diabetes (increases risk of hypertensive bleed)
Coagulopathies
Liver disease
Previous stroke
History of known vascular abnormalities (AVM, venous angioma)
Tumor: known history of cancer, especially those that tend to go to brain (lung, breast, GI, renal, melanoma) or associated with coagulopathy (leukemia)
Recent surgery: especially carotid stenting or endarterectomy, procedures requiring heparin
Recent childbirth and/or eclampsia or preeclampsia
