Physician's Assistant

Patient Details

Refined clerking (199 days ago 03:39)

Refined clerking Fri 19 September 2025 03:39

Last Modified: 199 days ago

MRN:

Content:

Medical ST5 Miller Clerking

Presenting Complaint:
Speech disturbance and weakness for 1 night

History of Presenting Complaint:
Patient went to bed at approximately 22:30 hours and woke up unable to lift himself from the mattress due to generalised weakness affecting both arms. Eventually managed to sit on edge of bed but experienced significant speech disturbance described as "talking total gibberish" - words were present but coming out in wrong order, unable to find desired words, described as similar to "playing scrabble but unable to get words together". No slurring noted. Speech symptoms gradually improved over time. Wife called 999 around 02:00 hours. Paramedics noted patient was not making complete sense but was relatively coherent. Also experienced transient loss of sensation in right shin during paramedic assessment which has since resolved. By hospital arrival, speech had returned to normal. No other episodes of weakness reported. Patient has been under significant stress recently caring for wife who broke hip in June and spent time in hospital.

Past Medical History:
• Prostate cancer -> Radical prostatectomy 2008
• Rising PSA with metastatic disease to para-aortic and left common iliac nodes 2008
• Hormone therapy 2018
• Hypertension 2009
• Postural hypotension 2019

Drug History:
• Decapeptyl SR 11.25mg IM every 3 months
• Pravastatin 10mg PO ON
• Ramipril 10mg PO ON
• Cyproterone 50-100mg PO OD-BD PRN

Allergy History:
• NKDA

Social History:
Lives with wife who has mobility issues following hip fracture in June. Recently retired horologist (watch/clock maker) in January but continues working part-time Active lifestyle including gardening and household maintenance. Minimal alcohol intake - occasional social drinking. Non-smoker.

On Examination:
General Appearance: Alert, well appearing
• Abdomen: Soft, non-tender
• Cardiovascular: Heart sounds normal, regular rhythm, good peripheral pulses, no peripheral oedema
• Respiratory: Chest clear to auscultation
• Neurological: Power 5/5 in all limbs, sensation preserved, reflexes normal, gait examined with no evidence of ataxia

Investigations:
• Creatinine: 105
• Cholesterol: 4.7
• Glucose: 6.7
• Urea: 5.4
• Blood count: Normal
• CT Head: No acute intracranial haemorrhage or acute infarct, no skull fracture

Impression:
Transient ischaemic attack with isolated speech disturbance and transient weakness, now resolved

Management Plan:
1. Commence antiplatelet therapy - aspirin and clopidogrel
2. Stroke team review
3. Stroke ward admission or TIA clinic review
4. Complete stroke blood panel
5. Review CT head results
6. Stroke unit bed

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Refined clerking Fri 19 September 2025 03:39

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