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An 89-year-old hemiplegic man is seen for a routine physical examination. Major right brain stroke produced permanent dense left-sided motor deficit years ago. Has related vascular dementia. Completed full isoniazid prophylaxis for newly positive PPD skin test 2 years back; underwent concomitant pyridoxine repletion. Has benign prostatic hyperplasia, urolithiasis, and esophageal reflux disease. Takes 14 medications, including warfarin, sotalol, tamsulosin, tizanidine for spasticity in the left hand, and quetiapine.
Man whose smile is evident and winning, notwithstanding left central facial palsy. Scabbed 1 cm basal cell carcinoma on right temple (neither he nor family wants it treated). Left hemiplegia. Flexion contracture at wrist, with padding and splint to prevent injury and retard progression. Verbal output sparse but mostly appropriate. Mouth as shown. Dentition and gums unremarkable for age.
INR, 2.8 (target therapeutic range for this patient, 2 to 3).
What's Your Diagnosis?
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