Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This elderly gentleman experienced transient speech disturbances and neurological symptoms involving the left upper limb; however, no focal signs are present.\n\nGiven the history of ischemic heart disease and atrial fibrillation, a transient ischemic attack (TIA) is a strong possibility; the subtherapeutic INR (indicating inadequate anticoagulation) lends further credence to this suspicion.\n\nOther differentials include hypoglycemia, electrolyte disturbances, a subdural hematoma or a cerebral tumor (with hemorrhage inside); however, these are made unlikely by his basic investigations, CT scan and transientness of symptoms even in the absence of treatment.\n\nAcephalgic hemiplegic migraine is another possibility, but a first presentation is some"}]}

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