Abstract

1. Please read the following passage.

A 38-year-old woman presented with sudden onset right hemifield visual disturbance associated with headache. The deficit resolved by the time she saw her family doctor the following day. However, the headache persisted over the next few weeks. She had difficulty sleeping and felt less sharp, and more irritable than usual. Four months later she represented with sudden onset left-sided weakness.

Her past medical history was unremarkable. Her only medication was aspirin 75 mg daily, started by her family doctor 3 weeks previously. She had no family history and did not smoke. Her mini mental state examination was 28/30 and she had a grade 4/5 left hemiparesis. General and neurological examination was otherwise normal.

FBC, Us and Es, LFTs, ESR, ANA, dsDNA, ANCA, ESR, CRP, blood cultures, HIV serology, ENAs, anticardiolipin antibody, clotting studies, chest xray, ECG, echocardiogram, MRA of neck vessels and angiogram were