A 69-Year-Old Man Who Has Sustained an Acute, Observed Stroke

AUTHOR:
Ronald N. Rubin, MD^1,2 —Series Editor

AFFILIATIONS:
¹Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
²Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania

CITATION:
Rubin RN. A 69-year-old man who has sustained an acute, observed stroke. Consultant. 2021;61(9):e28-e30. doi:10.25270/con.2021.09.00002

DISCLOSURES:
The author reports no relevant financial relationships.

CORRESPONDENCE:
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

A 69-year-old previously healthy man had experienced the acute onset of weakness in his right hand and arm after driving home from playing a round of golf. The weakness progressed quickly from paresis and poor control to essentially flaccid paralysis within a few minutes.

After seeing him sitting in the driveway for a while, the man’s wife came out to the car to see if he was OK. At that time, she had noted that the man could not articulate his speech (later he reported that he knew what things were and what he wanted to say, but the appropriate words would not come out). There was no loss of consciousness, headaches, or seizure at any time. He was immediately taken to a nearby large regional hospital for evaluation.

History and medical records revealed a very healthy man for his age with no history of hypertension or type 2 diabetes. He had borderline high cholesterol levels but was not taking statins. He was physically active, with more than 14 hours of physical activity per week via multiple high-skill-level senior softball leagues and golf (and he is among the elite players in both activities).

Physical examination results reveal vital signs in the normal range, including temperature, heart rate, and blood pressure. There were no cardiac murmurs. He had significant expressive aphasia and essentially flaccid paresis of his right hand and arm to shoulder. The remainder of his neurological examination was within normal limits.

Results of a battery of laboratory tests were unremarkable. An emergency computed tomography angiogram revealed an evolving cerebrovascular accident involving the left middle cerebral artery distribution. The attending emergency department physician, internist, and neurologist agreed with the impression that the severe ongoing clinical deficit seemed out of proportion to the lesion seen on imaging. The stroke had been observed, and the time elapsed from onset was 3.5 hours.

Answer and discussion on next page.