history of coronary artery disease

Summary: The patient is a 60-year-old, right-handed man with history of coronary artery disease, hypertension, and hypercholesterolemia, who presents to the emergency room with a 5-hour history of slurred speech and an inability to move his left arm and leg. He had an episode of amaurosis fugax (fleeting, painless, transient monocular vision loss) in his right eye 1 month prior to presentation of these symptoms. On physical examination, although he is alert and oriented, he has no awareness of his disability (anosognosia) and exhibits left-sided neglect, as well as significant hypertension, dysarthria, and left hemiparesis. He also has left-sided homonymous hemianopsia, conjugate rightward gaze deviation, left hemifacial weakness, and left hyperreflexia.