Sandbox:ssw 2

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Demographic / Medical history

• Demographic: 77, M
• Past Medical History: HTN, BPH, CAD w CABG, MI, AVR
• Past Surgical History:
  • AVR (#25 magna ease valve) on 12/14/17
  • Stent on 10/10/2017
  • CABG in 2007
  • Appendectomy in 1957

• Medications:
  • Metoprolol
  • DAPT
  • Tamsulosin

Procedure

• Index Procedure Date/Time:
  • mm/dd/YYYY at xx:xx [insert date and time]
• Index Procedure Detail:
  • On mm/dd/YYYY at xx:xx [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
  • Access site details
  • The site reported that there were/were not procedural complication(s).

Event(s)

Event (1):

• Site Reported Event Onset Date: 12/26/2017

• Event summary:
  • Symptoms and sign: Subject presented with
    • Right leg collapse,
    • Right arm and right leg weakness
  • Episodes lasted approximately 2 -10 minutes and ranged from 1-4/day
  • No visual or speech difficulties, no headache or neck pain
  • No history of vertigo, syncope, loss of consciousness or seizures
  • Other important symptoms related to the chief complaint.
  • Physical assessment:
    • Normal neurological exam
    • BP: 124/66
    • HR: 96

Laboratory data

• Lab studies list: (Date/ name/ value)
  • 01/04/2018 / HDLC / 31
  • 01/03/2018 / INR / 1.2

Diagnostic tests

• 01/03/2018 TTE
  • Mild left ventricular hypertrophy with normal systolic function and left ventricular diastolic dysfunction
  • Moderate left atrial enlargement
  • Bioprosthetic aortic valve peak vel 2 m/s and mean grad 6.4 hg, no AI
• 01/03/2018 MR Brain
  • NO evidence of vascular occlusion
  • No evidence of restricted diffusion to suggest infarction
• 01/03/2018 MRA H/N
  • Eccentric filling defect in the left internal carotid artery just distil to the bifurcation that may be from calcification / nonocclusive thrombus
• 01/03/2018 Carotid US(Preliminary)
  • Right: 1-49% stenosis of right internal carotid
  • Left: 1-49% stenosis of left internal carotid
  • Bilateral vrtebral arteries patent with antegrade flow
• 01/03/2018 EEG
  • Normal awake EEG
  • No epilitiform discharges, focal changes or other abnormalities

Consults

• Neurology consult : 01/03/2018
• Recommendations:
  • CBC,CMP
  • Admission to neurology service
  • MRI brain with or without contrast
  • MRA of the extracranial and intracranial circulation
  • Carotid duplex US
  • EEG
• Date and time of consult
• Suggested treatments:
  • Aspirin 81mg chew tab
  • Clopidogrel 75 mg tab
  • Enoxaparin 40mg inj
  • Metoprolol succinate 25mg extended release

Clinical course

• Date and time of events,
• Patient condition got worse or better.

Treatment and outcome

• List of relevant medical treatments
  • Aspirin 81mg chew tab
  • Clopidogrel 75 mg tab
  • Enoxaparin 40mg inj
  • Metoprolol succinate 25mg extended release
• Out come - Discharged home