Published 25 February 2009, doi:10.1136/bmj.b616
Cite this as: BMJ 2009;338:b616

Endgames

Case report

An episode of transient neurological symptoms

Colin B Josephson, neurology resident1, Rustam Al-Shahi Salman, MRC clinician scientist and honorary consultant neurologist2, Stephen J Phillips, professor of medicine (neurology)1

1 Department of Medicine, Division of Neurology, Dalhousie University, Halifax, NS, Canada B3H 3A7, 2 Division of Clinical Neurosciences, University of Edinburgh, Edinburgh

Correspondence to: S J Phillips stephen.phillips@cdha.nshealth.ca

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

A 72 year old, right handed man presented with weakness of the right hand and difficulty expressing himself, although he was able to comprehend those around him. The symptoms were maximal at onset and resolved spontaneously within one hour. He had a history of hypertension and type 2 diabetes mellitus. His only drugs were metformin and a thiazide diuretic. His neurological and general examinations were normal, and his blood pressure was 140/90 mm Hg. Computed tomography of his brain was normal.

1 What is the diagnosis?
2 Where is the lesion, and how might you confirm the diagnosis?
3 What are the immediate goals in evaluation and treatment?

1 Transient ischaemic attack (TIA).
2 Expressive aphasia and right hand weakness localise to the middle cerebral artery territory of the left hemisphere. The diagnosis of a TIA is usually made on the basis of the patient’s history. A relevant hyperintense lesion . . . [Full text of this article]


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