DR Delbanco: Mrs X is a 36-year-old left-handed woman recuperating from left hemiparesis that occurred in late December 1996. Married and the mother of 4 children, Mrs X has a large, caring extended family. Prior to the stroke, she worked in a warehouse in a job requiring physical labor. She is enrolled in a commercial managed care program. At the time of her stroke, she did not have a primary physician.
Prior to her stroke, the patient had been in good health. She has never smoked and had 4 uneventful pregnancies and deliveries. There was no prior history of hyperlipidemia, hypertension, rheumatic fever, or known rheumatic heart disease. There was no family history of vascular disease or stroke.
The week before the stroke, Mrs X had symptoms of a mild upper respiratory tract infection. While shopping, she suddenly slumped to the ground, unable to move her left side. At a