A 62-year-old builder is admitted with a history of collapsing while lifting heavy building blocks. In the A&E department he is unable to give a clear history, but his wife says he was previously well. He has smoked all his life and regularly drinks 8-10 pints of beer on a Friday or Saturday night. On examination in casualty, he was noted to be talking incomprehensibly and have to have moderate weakness of his right side. On arrival on the ward, 3 hours later, he appears awake but is no longer talking at all and responds only to some, but not all, commands. His head and eyes look towards the left. He moves his left arm and leg spontaneously, but even pinching the skin elicits no movement of his right arm or leg. There is no obvious difference in the tone or reflexes in his limbs, but the right plantar response is extensor. On general physical examination, you note he is overweight and his blood pressure is 220/120 mmHg. The remainder of your examination is normal. What is the most likely diagnosis? Left hemisphere intracranial haemorrhage Left internal carotid artery occlusion and cerebral infarction Posterior fossa haemorrhage with rapid-onset hydrocephalus Left hemisphere infarction with subsequent seizures Continuing emboli from internal carotid artery stenosis
Posted on: Mon, 21 Jul 2014 15:04:47 +0000
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