A thirty-nine year old Caucasian female patient with no history of stroke was hospitalized last month with a mild TIA. She was a pack a day smoker and a heavy drinker. CT and MRI revealed a number of silent cerebral infarcts, but no stroke-in-evolution. The patient is being treated with Warfrin (at 10mg/day). She has also stopped smoking and drinking.

She complains of an inability to focus or concentrate and poor short- and long-term memory, which culminated this morning in a non-syncoptic episode which she describes as ‘a lightning bolt to her brain’, the blood rushing from her head, lasting two or three seconds.

She denies having consumed anything that contains significant amounts of Vitamin K or other substances which interact with Warfrin, and also denies any strenuous activity.

She is now worried about the nature of the episode. The consulting neurologist was not available today, and she needs some reassurances that what occurred this morning was not a warning sign of something more dangerous to come.

Any clues as to what might be going on?

Regards,


SEAN WING