Sandbox:ssw 2

# 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
- AVR (#25 magna ease valve) on 12/14/17
- Stent on 10/10/2017
- CABG in 2007
- Appendectomy in 1957
- Medications:
Metoprolol
DAPT
Tamsulosin
- Metoprolol
- DAPT
- Tamsulosin

# Procedure
- Index Procedure Date/Time:
mm/dd/YYYY at xx:xx  
- mm/dd/YYYY at xx:xx  
- Index Procedure Detail:
On mm/dd/YYYY at xx:xx  the subject underwent a  for .
Access site details
The site reported that there were/were not procedural complication(s).
- On mm/dd/YYYY at xx:xx  the subject underwent a  for .
- 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
- Symptoms and sign: Subject presented with
Right leg collapse,
Right arm and right leg weakness
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Aspirin 81mg chew tab
- Clopidogrel 75 mg tab
- Enoxaparin 40mg inj
- Metoprolol succinate 25mg extended release
- Out come - Discharged home