An unusual cause of stroke

A woman in her 60s presented with acute onset numbness and weakness of the left arm and leg for three days on a background of fatigue and weight loss without headache over six months. She took ramipril for hypertension but was normally well. She was admitted under the care of the acute stroke team, and magnetic resonance imaging of the brain confirmed right middle cerebral artery territory infarction. Initial investigations also revealed biochemical evidence of inflammation (table 1). Neither atrial fibrillation nor carotid artery stenosis (on Doppler ultrasound) were identified as causes for her stroke. bmj;379/dec01_4/e066326/TBL1T1tbl1Table 1Results of initial investigation of patientTestResultNormal rangeHaemoglobin (g/L)89120-155White blood cell count (×109/L)11. 23.6-9.2Platelets (×109/L)890140-400C reactive protein (mg/L)140<5Plasma viscosity (mPa. s)2.381.48-1.72Empirical treatment for infective endocarditis was initiated, given the combination of lethargy, weight loss, raised inflammatory markers, and ischaemic stroke. However, blood cultures and transthoracic echocardiography were subsequently normal. Physical examination and computed tomography (CT)... Read Original Article: An unusual cause of stroke »