70-Year-Old Woman with Impaired Consciousness

Abstract

A 70-year-old woman was brought to the emergency department after being found unresponsive on the floor by her family. She was last seen normal six hours before presentation. Past medical history included uncontrolled type 2 diabetes mellitus, stage 3 chronic kidney disease, and hypertension. Clinical exam revealed; blood pressure 210/120 mmHg, pulse rate 80/minute, respiratory rate 18/minute, temperature 37°C, and oxygen saturation 99% on room air. The patient was stuporous; opened her eyes to pain, localized to pain with both upper limbs and had no verbal response (Glasgow Coma Scale 8). Her gaze was midline and pupils were 4 mm equal and reactive to light. Cardiac, respiratory, and abdominal exams were unremarkable. Blood glucose was 12 mmol/L. Computed tomography scan of the head showed no acute intracranial process. Magnetic resonance images of the brain are shown. The diagnosis was ischemic stroke resulting in bilateral paramedian thalamic infarctions, consistent with artery of Percheron stroke.

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