Case Presentation
An 82-year-old woman traveled from Kansas to celebrate her daughter's 50th birthday in California. After a nice party, she fell asleep at her daughter's house. Although she drank 2 glasses of wine during the party, she awoke the next day feeling fine, had breakfast, and saw her daughter off to work. However, when she spoke to her daughter on the telephone later that afternoon, the daughter noticed that her mother's speech was garbled and she seemed confused. The daughter rushed home and found her mother curled up on the couch in a fetal position, and she couldn't be aroused. The daughter called 911.
History and Physical Examination
The patient, a widow and retired secretary, lives alone in Kansas, drinks a single glass of wine weekly, is nonsmoker, and uses no drugs. Her medical history was significant for thyroid disease (for which she takes levothyroxine), diverticulitis, and gastrointestinal hemorrhage. Family history reveals that she has 2sons and 1 daughter who are healthy. Her mother and grandmother died following strokes, and her father died of myocardial infarction.
Review of Systems
In the emergency department, the patient complained of tingling of her lips and mouth and abdominal cramps. She had had a previous emergency department visit for abdominal pain 2 weeks ago, but the pain resolved without diagnosis or recurrence. She has otherwise been feeling completely well. Sometimes she uses a cane to walk, but generally she just carries it around.