Case 7 - Hemiparesis followed by dementia  pp. 47-54

By Yan Deschaintre, Fadi Massoud and Gabriel C. Léger

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Clinical history – main complaint

A 73-year-old woman presented to the emergency room with mild left hemi-paresis since awakening the day before. History was difficult to obtain from the patient. Her husband mentioned memory decline with functional limitations in the last few months. For example, he reported that she misplaced money and that he no longer let her go to the supermarket by herself.

General history

She was a right-handed, retired real estate agent living with her husband. They had no children. She led a sedentary lifestyle, smoked actively, and consumed two drinks of alcohol daily.

Past medical history included diffuse atherosclerosis with renovascular hypertension diagnosed at age 58, high blood cholesterol, and a right parieto-temporal ischemic stroke at age 71 with no apparent sequelae. There was no history of coronary heart disease.

Past surgical history included both right carotid endarterectomy and iliac angioplasty at age 58, and hysterectomy with bilateral salpingo-oophorectomy at age 35.

Medications on admission included aspirin 80 mg daily, cilazapril (Inhibace) 5 mg daily, irbesartan (Avapro) 150 mg daily, amlodipine (Norvasc) 10 mg daily, metoprolol (Lopresor) 100 mg am + 50 mg pm, terazosin (Hytrin) 2 mg daily, simvastatin (Zocor) 10 mg daily, ezetimibe (Ezetrol) 10 mg daily, and venlafaxine (Effexor XR) 300 mg daily.

Family history

Parents and siblings (ten sisters and seven brothers) had no particular medical history regarding vascular disease or dementia.

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