I saw this Indonesian man who came in a stretcher, sweating profusely, looked lethargy and a bit drowsy. He can’t really answer the question. I quickly browse thru the A&E admission note. It’s stated acute gastroenteritis (AGE). He had repeated vomiting for 12x and was not taking orally well since morning. No wonder, my initial conclusion that he looked so unwell. While I’m clerking, his friends giving him a drink and he jush cough violently as if he can’t swallow it.(????lost of gag relfex). Hey, that not right, i noted he had been lying that all the time with his gaze toward his right side and when i asked him to lift his arms, to my surprise, he can’t life his left arm and his can’t move his left leg at all. And when i asked his to stick his tongue out, it’s deviated to the left. Obviously this man had a stoke and it’s cause the left side weakness and the drowsy state.
This episode did teach me a lesson. Do a proper physical examination regardless the history. The patient and his friends had not give a history of left sided body weakness, instead giving the impression of major complaints of vomiting.
Unfortunately the patient did not do well. I was away at periphery ward and was back to doing call at the ward 3 days later. I looking for the patient, and I was told that patient had already passed away due to frontal and temporal lobe infarct.