Jose Perrez is a 60 year old man who comes to your outer metropolitan Emergency Department at 08.30 am, with what looks like a stroke.
He went to bed at 10 pm last night as usual. At 3 am he got up to go to the toilet and fell.
He reports he was struggling to stand afterwards, but he got himself back to bed. At 7 am he fell again while walking to the kitchen, this time witnessed by his wife. She called an ambulance.
He had a past medical history of sleep apnoea, obesity, hypertension and impaired glucose tolerance.
He takes carvedilol, lercanidipine and atenolol and is not on aspirin or any other anticoagulant. He has no allergies.
He’s usually independent for all activities of daily living and drinks 10 standard drinks per day.
On examination you find:
Alert and oriented
Left-sided visual/sensory neglect
Left-sided homonymous hemianopia
Partial left-sided weakness of left upper and lower limb
Dense sensory loss of left upper and lower limb
Mild-to-moderate dysarthria
Noted significant right lower limb pitting oedema of unclear chronicity – ?DVT
> This is a NIHSS of 14 (explained later in case you’re unfamiliar)
Can you give a few differential diagnoses for his presentation?
What are your TWO immediate priorities?