Author: Mohamed Gresha / Editor: Nick Tilbury / Codes: CC1, CP1, NeuC12, NeuP4, SLO1, SLO2, SLO6 / Published: 24/06/2022

A 51-year-old female presents to the Emergency Department (ED) with a sudden onset epigastric pain that started 6 hours ago. She then developed left sided facial droop and left arm and leg weakness about an hour later.

She has no significant past medical history apart from chronic sinusitis.

Her observations are as follows:

  • HR – 91
  • RR – 20
  • SpO2 – 96% on air
  • BP – 102/63 (182/93 when paramedics first assessed the patient)
  • CRT – 2 sec
  • GCS – 15

On examination the patient’s pupils are 4 mm, equal and reactive to light, and the left arm has power of 3/5, however the facial droop and the left leg weakness now appear to have resolved.

ECG shows sinus rhythm, with ST elevation of 2 mm in V1-V6 with no reciprocal changes.