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An 84-year-old woman presents to an emergency department (ED) in Elmira, New York, after collapsing on the floor of her home; her speech is slurred and she has weakness and loss of vision on the right side of her body. She says she felt fine before her collapse, and had not had any convulsions or loss of consciousness.
She has a history of atrial fibrillation, high blood pressure (for which she takes lisinopril), chronic obstructive pulmonary disease, and lung cancer (treated with a left upper lobectomy). About 3 months previously she had a gastrointestinal bleed, and her anticoagulation therapy was discontinued.
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