Weak 2

A 45 year old lady of South Asian origin presents with sudden weakness of her left arm and right leg for 8 hours. There was no associated slurring of speech, difficulty in swallowing, or sensory disturbances.

She was diagnosed with delusional disorder 3 months ago, after experiencing paranoid delusions for 1 year, and is currently on treatment with haloperidol.

Her medical and surgical histories are unremarkable, and there is no family history of stroke, heart disease or thrombotic disorders.

She is not on oral contraceptives, has never been pregnant, and does not smoke or consume alcohol. She denies using recreational drugs.

Serial ECGs are found to be normal, while her random capillary blood glucose is 105 mg/dL.

Her complete blood count is significant for a platelet count of 68,000/mm3. ESR, CRP, serum electrolytes, and her liver and renal profiles are all normal.

Select Relevant Investigations
MRI Brain

Performed

The MRI scan reveals multiple cortical infarcts involving both hemispheres.
Echocardiography

Performed

The echocardiogram shows an ejection fraction of 70% with no valvular abnormalities, intracardiac thrombi or akinetic segments.
Serum Homocysteine

Performed

Serum homocysteine levels are within the normal range.
Antiphospholipid Screen

Performed

Lupus anticoagulant: moderately positive
Anticardiolipin antibody: moderately positive
ANA and dsDNA: negative

Select Relevant Management
rTPA
Enoxaparin
Warfarin
Corticosteroids