January 2022 Critical Care Case of the Month: Ataque Isquémico Transitorio in Spanish

Saturday, January 1, 2022 at 8:00AM
Rick Robbins, M.D. in ADAMS-13, TIA, TTP, indirect bilirubin, jaundice, rituximab, scleral icterus, thrombotic thrombocytopenic purpura, transient ischemic attack, treatment

Mohammad Abdelaziz Mahmoud DO MD

Bo Gu MD

Benito Armenta BA

Nikita Samra

Doctors Medical Center of Modesto and Emanuel Medical Center

Modesto and Turlock, CA USA

 

History of Present Illness:

The patient is a previously healthy 61-year-old Spanish-speaking woman who was unable to speak after awakening. Per Emergency Medical Service she was found to be aphasic upon their arrival. While in the Emergency Room the patient was able to speak, alert and oriented x4, with all her symptoms spontaneously resolved. The patient denied fever, chills, blurred vision, headache or any history of migraines, TIA, or stroke.

The patient had a similar event about two weeks earlier which also spontaneously resolved. During that time, the patient had a non-contrast CT head and an MRI of the brain, both of which were unremarkable. Her home medications include aspirin 81 mg and atorvastatin 40 mg daily.

Past Medical History, Family History and Social History

The patient denies tobacco use or use of illicit drugs.  She reports that she will occasionally drink alcohol. There is no family history of strokes.

Physical Examination

• Vitals:  BP 123/80 mm Hg, T-max of 36.5° C, heart rate 72 bpm, SpO2 97%
• HEENT: scleral icterus.
• Lungs: clear
• Heart: regular rhythm
• Abdomen: soft without organomegaly, masses or tenderness
• Skin: jaundiced 
• Neurological examination:
  • Alert and oriented x4 with no focal neurological deficit observed
  • Cranial nerves II to XII were intact
  • Normal motor function
  • Normal speech
  • No facial asymmetry or facial droop
  • Normal mood and affect

Which of the following laboratory tests should be ordered? (click on the correct answer to be directed to the second of eight pages)

1. None. She should be sent home
2. Serum calcium/phosphorus 
3. Liver function studies
4. 1 and 3
5. All of the above

Cite as: Mahmoud MA, Gu B, Armenta B, Samra N. January 2022 Critical Care Case of the Month: Ataque Isquémico Transitorio in Spanish. Southwest J Pulm Crit Care. 2022;24(1):1-5. doi: https://doi.org/10.13175/swjpcc051-21 PDF 

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).