Facial Droop and Speech Difficulty

🗒️ Question

A 74 year old woman presents in ED after a sudden onset of right-sided weakness and difficulty speaking lasting for two hours. She was diagnosed with a left middle cerebral artery ischaemic stroke three days ago and has been treated with aspirin 300 mg daily. Her past medical history includes atrial fibrillation and hypertension for which she takes amlodipine and warfarin. She has no known drug allergies.

On examination, her blood pressure is 150/90 mmHg, heart rate is 82 bpm and irregular. Neurological examination confirms right-sided weakness with facial droop and slurred speech.

Investigations

• Haemoglobin: 140 g/L (115–150)

• Platelets: 180 x 10^9/L (150–400)

• INR: 2.8 (2.0–3.0 for atrial fibrillation management)

• Creatinine: 80 μmol/L (60–120)

Which adverse effect of her medication is most likely contributing to her presentation?

(A) Amlodipine-induced peripheral oedema

(B) Aspirin-induced gastritis

(C) Warfarin-related intracranial haemorrhage

(D) Amlodipine-related dizziness

(E) Aspirin-induced tinnitus