Published 11 February 2009, doi:10.1136/bmj.b90
Cite this as: BMJ 2009;338:b90

Endgames

Case report

Hemiparesis in a 36 year old man

Michael V Holmes, academic clinical fellow (specialty trainee)1, Atul Mehta, consultant haematologist2, Marsha Y Morgan, reader in medicine and honorary consultant physician3

1 Department of Clinical Pharmacology, Clinical Research Facility, St Thomas’ Hospital, London SE1 7EH, 2 Department of Haematology, Royal Free Hospital, Royal Free Hampstead NHS Trust, London NW3 2QG, 3 Centre for Hepatology, Department of Medicine, Royal Free Campus, University College London Medical School, London NW3 2PF

Correspondence to: M Y Morgan mymorgan@medsch.ucl.ac.uk

The first 150 words of the full text of this article appear below.

A 36 year old man presented in May 2006 with sudden onset of left facial droop, together with weakness and numbness affecting his left side. There were no prodromal symptoms and no history of trauma. His Glasgow coma score was 15/15, the left nasolabial fold was partially obliterated, and there was a left sided hemiparesis (Medical Research Council (MRC) grade 4/5) with pronator drift and an extensor plantar reflex. His pulse was 72 beats/min and regular, his blood pressure was 116/71 mm Hg; a non-radiating aortic ejection systolic murmur was heard, but no carotid bruits. The rest of the examination was unremarkable.

His haemoglobin was 228 g/l (reference range 133-170 g/l); his packed cell volume was 0.68% (0.39-0.52%), and his erythrocyte count 6.96x1012/l (4.3-5.6x1012/l); his red cell indices were normal; his white cell count was normal at 5.3x109/l (3.5-11x109. . . [Full text of this article]

Box 1: Classification and pathogenesis of strokes
Box 2: Classification of absolute erythrocytosis1 2 3

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