Case presentation An 85-year-old woman is investigated by her general practitioner (GP) for increasing tiredness, which has developed over the past six months. She has lost her appetite and feels constantly nauseated. She has lost about 8 kg weight over the past six months. She has also complained of generalized itching and cramps for the last four weeks. Medical history She has been hypertensive for 20 years and has been on antihypertensive medication for that time.
She has had two cerebrovascular accidents, which have left her with some left side weakness and reduced mobility. Examination Her conjunctivae are pale. Her pulse is 88/min regular, blood pressure 190/110 mmHg, with mild pitting edema of her ankles. Cardiovascular and respiratory systems are normal. Neurological examination shows a left upper motor neuron facial palsy with mild weakness and increased tone and reflexes in…
