Next patient sheila shepherd 76961 2 cranial 1 51 from 2 in july potassium 4.9 sodium 138 alp 238 from a 175 the remainder of lat is normal without jaundice crp 13 the urease 17.8 full full blood count 1,122 blood gas no acidosis ct head no acute intracranial hemorrhage or ischemia age related cerebral atrophy and bilateral oligodendrocyte no skull fracture past medical history osteoporosis congestive heart failure ckd 4 af acute nstemi 20 21 pacemaker in situ 2016 for complete heart block osteoarthritis hypertension medications history mirtazapine 50 mg at night furosemide 40 mg in the morning laxido 1 sachet per day hi doctor nice to meet you I'll put the my torch on is that okay yeah so we can vaguely see each other but I don't wanna wake you up too much I I will be happy to do what else do you do for fun do you walk you don't meet many people who have lived through that within london no always practicing pediatrics alright some water no no no what I meant was I dry up and reminisce oh I see not physically well if it's physical because I'm looking for the next word we're gonna have a look and see what your eyes are doing at the moment thank you if I were up 1 of your eyes do you mind left eye closed so first thing open your left eye lovely can we try the test again then if you if I cover up your left periphery of your vision can you see my finger oh is that better where's my finger going yeah you need to wiggle your toes and move your feet while I push it's so close very good 1 more on try again oh fine thank you alright fair enough yeah not fair power in all your limbs I can't see any facial droop when you you may have that hemianopia but it's difficult to assess at the moment isn't it when you're ex o'clock in the morning well somebody comes in there's a blood test so that I can look at the results of the alright any questions for me or anything I've forgotten yes I've got to be honest I've not got well it's not too long but I'm sure it's nicer at home is it not I just don't think we're I'm sorry I saw you when compared oh no no compared to other ones it's a lovely hospital better home it's not the same oh I'm robert miller I'm the 1 of the medical registrars I'm the medical registrar on tonight yes of course so so she's staying with us so on examination good power all 4 limbs vision difficult to assess as patient not able to open eyes very widely but doesn't have hemianopia on examination of the visual fields struggled with left lateral hemianopia however full vision in the right eye normal heart sounds normal respiratory sounds soft nontender abdomen chronic venous changes in the legs but without evidence of infection or cellulitis dressed wound to the right arm no clear facial droop on smiling however slightly fatten flattened left nasolabial fold which spares the forehead impression seems possible however atypical presentation with headache as primary as presenting symptom and unclear neurology regardless, at age of 100 and with functional baseline and symptoms, would not be candidate for revascularization therapy and, I feel that discharging back to the residential home in the morning would be the most sensible approach playing home tomorrow would consider antiplatelets however medicines have been rationalized that the nursing home is at risk of stroke due to atrial fibrillation not anticoagulated and symptoms are not disabling currently history of presenting complaint 3 days of headache described as severe splitting frontal headache then today, at 3 dizziness headache and slurred speech care home full stop speech symptoms had resolved by the time ambulance crew arrived full stop however, ambulance crew identified left sided lean with left sided visual disturbance and left visual field defect stop social history residential home independent in toileting and eating walk has been recently rehabilitating walking up to meters with zimmer frame on examination no dysarthria or aphasia flattening of the left nasolabial fold however no significant facial droop full stop patient clearly very tired and struggling to maintain her eyes open to fully assess visual fields however no clear lateralizing visual field deficit to my examination he's leaned to the left however no inattention to my assessment however assessment was challenging coco impression possible small lacuna infarct or tia if symptoms are not resolving bye thank you you alright ecg atrial flutter demand pacing rate of 85