Case presentation

A 65 year old, right handed, retired police inspector presented to hospital as an emergency. That afternoon, while decorating, he had complained of a headache, although it did not prevent him from continuing with his work. Three hours later, however, his wife found him unable to speak, with a drooped right face and shortly afterwards, complete right sided paralysis. He was known to have hypertension and, 3 months earlier, he had been investigated for weight loss and painless obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) had shown an impacted gall stone and appearances consistent with a periampullary tumour, although no histology was obtained. Sphincterotomy had led to improvement and the diagnosis had not been pursued further. Routine screening had also disclosed a lymphocytosis of 8.25×10⁹ /l, which was confirmed to be due to an asymptomatic, early chronic lymphocytic leukaemia. His medications consisted of 100 mg atenolol daily, 25 mg mefruside daily, and 400 mg cimetidine twice . . . [Full text of this article]