Notes

Patient reported she was in her usual state of health until yesterday afternoon when she was having lunch with family and suddenly started having slurred speech and has been episodic and reported that she also had swallowing problems. It was a transient episode but she still have residual slurred speech so family decided to bring the patient to the hospital. Patient reports that last night her blood pressure was elevated but otherwise it fluctuates Patient denies any other focal deficits. Denies balance issues, denies lightheadedness, dizziness, changes in vision.
No trauma reported. Patient denies any other symptoms, denies chest pain, shortness a breath, fever, chills, cough, abdominal pain, nausea vomiting or diarrhea.
 
Patient reports that she had this similar episode about 5 weeks ago that she had transient slurred speech, she went to her PCP had a CT scan done that was unremarkable, her symptoms were resolved.
 
In ER, patient had elevated blood pressure, otherwise vitals unremarkable
Rivera consensually unremarkable, TSH 3.91
-CT head with no acute abnormalities, CT angio head and neck with no arterial occlusion
-MRI brain consistent with bilateral acute nonhemorrhagic infarcts superior lateral ventricles both sides. Atrophy and moderate-to-severe nonspecific bilateral subcortical and periventricular white matter disease.
Patient was seen by neurologist in the ER and recommended to admit the patient to the hospital
 
Patient reported that her slurred speech is getting better. Family reported that his speech is little different but getting better.
 
Past medical history: Hypertension, history of intracranial hemorrhage more than 30 years ago after motor vehicle accident.