Ms. Smith, a 45 year old woman, presented to the Emergency Department at 10:00 am from her home with right sided facial droop and expressive aphasia. She first noticed the facial droop after using the restroom to have a bowel movement. She also reported having a terrible headache with auditory ringing and visual disturbances reported as “blurred colors that blocked my vision.”
Reports dyspnea upon exertion
Blood Pressure: 140/85 mmHg
Electrocardiogram was negative for dysrhythmias.
Echocardiogram was negative for right sided chamber dilation or ventricular hypertrophy.
Initial CT scan was negative for cerebral hemorrhage, ruling out stoke symptoms caused by brain bleed.
Past Medical History
- Regular headaches, no diagnosis of migraine. No previous experience with aura.
- Reported headaches 1-2/week.
- Treats with OTC: Excedrin Extra Strength. Minimal Relief
- Diagnosis of morbid obesity at age 39 with systemic hypertension. Began dietary changes and including light physical activity into weekly schedule, resulting weight loss of 30 pounds; maintained today.
- Current BMI: 37
- Benign hypertension, treats with diet and light exercise.
- Refused medications
Social History
- Unmarried; lives alone.
- Walks 3x/week at local gym with friends. This is a regular social gathering for Ms. Smith.
- Returned yesterday from a scuba diving trip; Ms. Smith was a first time diver.
- Non-smoker, no exposure to secondhand smoke
- Drinks 2-4 alcoholic beverages per week; generally on the weekend
- Occupation: Customer service representative
Family History
- Maternal grandmother died at 73 from cryptogenic stroke.
- Sister experiences frequent headaches as well. Otherwise unremarkable.
- Mother had hypertension. Died of MI at age of 64.
- Patient reports that mother occasionally had debilitating headaches, and would stay away from light and noise during a headache attack.
- Patient states, “Mom would withdraw until the head pain subsided. She even missed her own anniversary party one year.”
- No official diagnosis of which patient is aware.
- Father has Diabetes Mellitus Type 2, diagnosed at 67. Still alive.