Case 114 -- Transient Ischemic Attacks

Contributed by Nancy C. Karpinski, M.D. and Henry C. Powell, M.D.
-- Department of Pathology, U.S. Department of Veteran's Affairs Medical Center, La Jolla, CA and UCSD Medical Center, Division of Neuropathology, San Diego, CA
Published on line in September 1997


PATIENT HISTORY:

A 60-year-old male with a history of diabetes mellitus, tobacco use, and hypertension presented with a chief complaint of transient right-handed clumsiness and slurred speech. There was a three-day history of headache, nausea, vomiting, and falls. Medications on admission included insulin, lasix, and fosinopril. White blood cell count (WBC) was 12.5 x 109/L with a predominance of segmented neutrophils, but absent left shift. A chemistry panel and urinalysis were unremarkable. Initial neurological examination was non-focal and head CT was normal. Carotid ultrasound showed up to 70% stenosis of both the left and right internal carotid arteries. An admission diagnosis of transient ischemic attack was made and acetylsalicylic acid was given. There was a progressive decline in neurological function with dysarthria, ataxia, delirium, and lethargy. A diagnostic lumbar puncture was performed and appropriate pharmacotherapy was begun. A repeat head CT was abnormal demonstrating an anterior cerebral artery territory infarct. The patient died three weeks after admission of associated complications.

GROSS DESCRIPTION

MICROSCOPIC DESCRIPTION

FINAL DIAGNOSIS


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