19th August 2024

A 62-year-old woman presents to A&E with speech disturbance and facial weakness. Her husband

A 62-year-old woman presents to A&E with speech disturbance and facial weakness. Her husband reports that she suddenly became incomprehensible during breakfast that morning and her face drooped causing her tea to spill out of her mouth. He reports that over the last week she has reported slight weakness and numbness of the left leg, but has not sought medical attention for this. She has a background of mitral valve prolapse under surveillance, hypertension and asthma. On examination, she is alert. Her heart rate is 89 bpm and regular, respiratory rate 18, saturations 97% on air, blood pressure 120/70 mmHg and temperature is 38.2 degrees Celsius. Her blood sugar is 5.6 mmol/L. She has a receptive aphasia and obvious facial weakness on the right side with forehead sparing. She has reduced power of the left leg, with some subjective numbness and sensory inattention and brisk reflexes. Examination of her cardiorespiratory system reveals a pansystolic murmur. A CT head demonstrates no haemorrhage. Which investigation should be performed next to identify the cause of her neurological disturbance?

Select the SINGLE most appropriate option from the list below. Select ONE option only.