Clinical Reasoning: An 81-Year-Old Woman Who Insisted the Hospital Was Her Home

Abstract

An 81-year-old right-handed white non-Hispanic previously healthy woman with glaucoma presented with acute weakness and slurred speech nearly 10 hours after last seen well. She was found to have new onset atrial fibrillation. Her NIH stroke scale (NIHSS) was 18 with points given for failure to answer questions, left lower facial paralysis, right gaze preference with ability to cross midline, left field cut, left hemiplegia, severe dysarthria, mild aphasia, and severe left sensory neglect.