Case 37-1999

Presentation of CaseA 72-year-old, right-handed woman was admitted to the hospital because of slurred speech and agitation.The patient had a long history of hypothyroidism, hyperlipidemia, and angina pectoris. Five years before admission, a St. Jude Medical prosthetic valve had been inserted to replace a stenotic aortic valve; a double coronary-artery bypass graft was also performed because of severe, symptomatic coronary artery disease. Warfarin therapy was begun.Several months before admission, the patient began to eat less and lost a considerable amount of weight. She continued her warfarin therapy. During the three months before admission, she had headaches and . . .