Case Studies

Case 2: A 65-year-old man who collapsed while walking his dog (Part 4 The nervous system)

A 65-year-old man who has collapsed has been brought into A&E with confusion, numbness or weakness, resulting in complete paralysis of one side of the body and sudden loss of vision. He is a smoker of 20 cigarettes per day, is overweight and hypertensive. His past medical history indicates that his lipid levels are elevated and his GP has prescribed simvastatin 20 mg to lower his cholesterol.

On examination, you find that he is confused, incontinent of urine and has weakness on the right side of the body. Visual signs are decreased in a pattern with homonymous hemianopia.

• 1. What are the risk factors associated with his diagnosis?

• 2. What are the investigations that could be carried out to aid diagnosis?

• 3. Discuss some of the immediate care he will require on admission to the ward. Remember that early rehabilitation improves his chance of survival.

• 4. What advice will you give him before he is discharged home?