When the patient arrives, she is dressed up with nice clothing, makeup, and high-heel shoes. She looks like she was out at the clubs. In fact, she was drinking at home with her boyfriend and was getting ready to go out to a bar.
Then there was an argument. The patient was able to “feel her blood pressure going up.” She demanded that her boyfriend apologize for the things he said to her. He refused. She sat in a chair, grabbed her head with both hands, and went “unresponsive.” She didn’t “wake up” until she arrived in the emergency department and had no idea what happened.
It must have been a stroke. She was sure of it, because this was her eighth stroke and she was on full disability from all of her other strokes.
Eight strokes at age 27. How horrible.
I did a pretty good neuro evaluation and found nothing abnormal on her exam. No weakness. No speech problems. No coordination issues. Maybe some alcohol on the breath, but no neurologic problems.
Seeing an essentially normal patient in front of me, I asked “Soooooo …. exactly what part of your body was affected by all those strokes you had?”
She looked back at me, rolled her eyes and said “My BRAIN, duh.”
Ooooh. Good one. Obviously your sarcasm center wasn’t affected.
It ended up being a very long night.