Stroke

doi:10.1136/bmj.b783

Published 4 March 2009, doi:10.1136/bmj.b783
Cite this as: BMJ 2009;338:b783

Endgames

OnExamination Quiz

Stroke

The answer to this question, and more questions on this topic,are available from www.onexamination.com/endgames until midnighton Wednesday.

This week’s quiz is on stroke and is taken from the MRCPand MRCPI examinations.

A 35 year old woman was admitted to casualty after developingrestlessness, hallucinations, and acute confusion. The symptomscame on within minutes of her having taken sumatriptan for migraine.

On admission she was vomiting and sweating profusely and seemedto be confused, with a Glasgow coma score of 14/15. Her bloodpressure was 162/90 mm Hg, her pulse was 102 beats per minuteand regular, and her temperature was 38.9°C. Heart soundswere normal, and her chest was clear on auscultation. A cranialnerve examination including fundoscopy was normal. Examinationof the peripheral nervous system revealed normal tone, withfour beats of ankle clonus bilaterally. Her reflexes were globallybrisk, although power, sensation, and coordination were allnormal.

The patient was taking fluoxetine for depression and sumatriptanfor occasional migraines. She was a non-smoker and drank 10units of alcohol a week.

Investigations showed: sodium 135 mmol/l (normal 137-144), potassium3.9 mmol/l (3.5-4.9), urea 8.9 mmol/l (2.5-7.5), creatinine130 mol/l (60-110), haemoglobin 10.2 g/dl (11.5-16.5), whitecell count 12x10⁹/l (4-11x10⁹), platelets 100x10⁹/l (150-400x10⁹),prothrombin time 20.2 s (11.5-15.5), activated partial thromboplastintime 50 s (30-40), fibrinogen 7.8 g/l (1.8-5.4).