Education And Debate

A Difficult Case: Case report

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6992.1449a (Published 03 June 1995) Cite this as: BMJ 1995;310:1449
  1. R J Davenport, clinical research fellow in neurologya,
  2. I R Starkey, consultant cardiologistb,
  3. C V Ruckley, professor of vascular surgeryc,
  4. M S Dennis, senior lecturer in stroke medicinea,
  5. P A G Sandercock, reader in neurologya,
  6. C P Warlow, professor of neurologya
  1. a University Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU
  2. b Department of Cardiology, Western General Hospital, Edinburgh EH4 2XU
  3. c University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW

    A 60 year old right handed barman was referred to the regional cardiology service for consideration for coronary angiography. He gave a 12 month history of chest pain on exertion and recently of pain at rest. At his local hospital a 12 lead electrocardiogram had shown an old full thickness inferior myocardial infarction and exercise testing had yielded a moderately positive result. He had stopped smoking in the previous six months and did not have diabetes or hypertension. He was taking atenolol, nitrates, and aspirin. On the day before referral he suddenly developed weakness of the right arm …

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