Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is an 83-year-old woman who presents to the ED by ambulance after her daughter found her on the couch very confused. She did not know what had happened or even where she was, and did not seem to be able to use her right arm. The daughter recently found out that her mother had forgotten to fill her prescriptions, and it was a week before the daughter recently found out that her mother had forgotten to fill her warfarin prescription.
ROS –
CV: +palpitations,
Musculoskeletal: can’t move right arm.
PE –
VS: BP 168/92, P: 89 and irregular.
CV: rhythm is irregular.
HEENT: Right-sided CN 7 defect (facial droop).
Musculoskeletal: Hemiparesis of right arm.
Labs: Neuroimaging shows no hemorrhage, imagery relevant to ischemic stroke due to left atrial emboli.