tokens: 130959255 FIH 1431063 10119/hy66 738478 6/15/1994 12:00:00 AM RIGHT OCCIPITAL HEMORRHAGIC STROKE . Unsigned DIS Report Status : Unsigned ADMISSION DATE : 6-15-94 DISCHARGE DATE : 6-26-94 PRINCIPAL DIAGNOSIS : Right occipital hemorrhagic stroke . HISTORY OF PRESENT ILLNESS : Ms. Tlandkotesmitskote is a patient who came complaining of feeling dizzy and bumping into objects on her left side . She is a seventy-one year old female with a history of hypertension who is in otherwise good health . This morning while on a cruise ship , she was eating breakfast when she suddenly noticed she could not see a roll on her plate although she knew that it was there . She also felt dizzy and the room was spinning . While walking , she kept bumping into object on her left side . She also complained of a dull , right sided headache over the right eyebrow . Symptoms lasted about five hours and then gradually resolved except for the change in vision . She denied having any weakness , numbness , or pain . She also denies having hoarseness , difficulties in finding words , speaking , hiccups , or diplopia . PAST MEDICAL HISTORY : The past medical history is significant for hypertension . The past surgical history is negative . MEDICATIONS ON ADMISSION : Atenolol , 25 mg PO qd . ALLERGIES : The patient has no known drug allergies . REVIEW OF SYSTEMS : On review of systems , the patient denied any history of transient ischemic attacks . FAMILY HISTORY : Father and mother died in their eighties of heart disease . SOCIAL HISTORY : The patient denied using tobacco . PHYSICAL EXAMINATION : On physical examination , she was a very pleasant , moderately obese female in no apparent distress . She was afebrile and her vital signs were stable . The head was normocephalic and atraumatic . The pupils were equal , round , reactive to light . The tympanic membranes were gray . The fundi were sharp . The neck was supple with full range of movement . The lungs were clear to auscultation bilaterally , without rales or wheezes . The heart had a recovery regular rate and rhythm . The abdomen was soft , nontender , nondistended . Extremities revealed 2+ pitting edema in the knees bilaterally . The neurological examination revealed that the patient was awake , alert and oriented to person , place and time . She was able to subtract serial sevens , remember three out of three objects after five minutes , and there was notable aphasia or word finding difficulty . The cranial nerves showed pupils were bilaterally active from 3 to 2 mm . There was a dense hemianopsia on the left side . The extra ocular muscles were intact bilaterally . Corneals were present bilaterally . Sensation was intact to light touch and pin prick bilaterally . Face was symmetric . Eye closing was tight . Hearing was intact bilaterally . Palate was midline . Gag was intact . The sternocleidomastoid and trapezius had good strength . Tongue was midline . Strength was 5/5 in bilateral upper extremities and bilateral lower extremities in detail . There was no pronator drift . Sensation was intact to light touch , pin prick , and proprioception . Cerebellar examination revealed in intention tremor on the right side . The patient had considerable difficulty with left finger-to-nose movement , most likely secondary to hemianopsia . There was no nystagmus , except for some fine fast beat nystagmus bilateral extremes of abduction . Reflexes were symmetric and 2+ bilaterally at the biceps tendon , 2+ bilaterally at brachial radialis , 2+ bilaterally at the patellar tendon , 1+ bilaterally Achilles tendon . The toes were downgoing bilaterally . Gait : patient had difficulty with tandem gait and fell forward while standing on his his toes . Otherwise , the gait was normal . LABORATORY DATA : Laboratory studies on admission demonstrated a sodium of 144 , potassium 4.1 , chloride 106 , bicarbonate 20.0 , BUN and creatinine 12/0.7 , glucose 99 , white blood count of 5.7 , hematocrit of 40.6 , platelet count of 226 , prothrombin time was 9.4 , partial thromboplastin time was 29 . The computerized tomography scan was performed and showed a right occipital hemorrhage . SUMMARY : The patient is a seventy-one year old female with a history of hypertension who now presents with a right occipital hemorrhagic stroke . HOSPITAL COURSE : The patient was admitted to the hospital for further evaluation and work up . The patient was admitted to the Intermediate Care Unit in the Neurology Intensive Care Unit . However , she was soon moved out of there as her examination appeared to be stable . A Neurosurgery Service consultation was obtained and they felt that no surgical intervention was required . The patient underwent a number of tests . She had a magnetic resonance imaging study and magnetic resonance imaging angiogram performed which showed a large hemorrhagic lesion on the occipital lobe . There was no clear enhancing mass , but follow up was suggested . So an magnetic resonance imaging angiogram was obtained and showed the right parietal occipital hemorrhage . The MRA showed mild narrowing of the left ICA just distal to the bifurcation . There was also scattered T2 hyperintense foci within the periventricular and left frontal white matter consistent with small vessel disease , gliosis or demyelination . A Holter monitor was obtained and showed that the patient was in normal sinus rhythm . The heart rate was 53 to 106 . There were some very rare atrial premature contractions . There were no ventricular premature contractions . An echocardiogram was obtained and showed that the ejection fraction was 60% and there was no thrombus . It was felt to be within normal limits . Over the ensuing days , the patient had several episodes of confusion at night . However , these gradually resolved . She also developed what appeared to be urinary tract infection and was placed on PO Bactrim . By 6-26-94 , the patient was felt to be ready for discharge . At that time , she was afebrile and her vital signs were stable . She was tolerating a regular diet . She was awake , alert and oriented to person , place , and time . She continued to have a dense left hemianopsia , but otherwise was neurologically intact . The patient was discharged home with Santea Gehawhi General Hospital care and instructed to follow up . MEDICATIONS ON DISCHARGE : The patient was discharged on Tenormin , 25 mg PO qd ; Bactrim DS , one PO bid x5 days . TATAJO SEE , M.D. TR : ba / bmot DD : 8-4-94 TD : 08/06/94 CC :