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We present a male-to-female (MTF) transgender patient admitted with a pulmonary embolism. The patient had been treated with high-dose oestrogens since the age of 16. Following a prolonged period of hypotension, our patient sustained cerebral border zone infarcts. There was evidence of bilateral carotid stenosis on Doppler ultrasound. We discuss the treatment and vascular complications of gender dysphoria.

Post-stroke homonymous visual field (PSHVF) loss has functional and driving implications for patients. Automated, as opposed to confrontational, assessment of PSHVF loss has the potential to provide a more reliable indicator for field loss and thus ability to drive. Sixty-one consecutive stroke admissions were assessed at 9 months post-stroke. Driving status and the patient's awareness of any visual field loss was ascertained. Patients underwent formal perimetric visual field testing using a Humphrey Visual Field Analyser II. A separate, blinded, confrontational assessment of visual fields was made using the National Institutes of Health Stroke Scale (NIHSS) technique. Homonymous field defects were found in 10 (16%) patients, with 50% of these being hemianopia and 50% quadrantanopia. Right-sided field loss was more common (70%). No patients with PSHVF loss were aware of their loss, and only two were detected using NIHSS assessment. One patient was thought to have PSHVF loss on NIHSS assessment but this was not confirmed on perimetry. Of those with significant PSHVF loss at 9 months, 30% were driving. The prevalence of PSHVF loss is relatively high and is underestimated by confrontational testing. Stroke patients are often unaware of their field loss, with up to 5% driving with significantly affected visual fields at 9 months. Perimetric testing may be useful in decision-making regarding driving eligibility post-stroke.

Background: Early identification of mood disorder post-stroke (MDPS) or its determinants could improve stroke outcomes. However, the natural history, prevalence and determinants of MDPS within the first weeks post-stroke require further investigation., Methods: Consecutive hospitalised stroke survivors were assessed within 2-5 days of stroke, and at 1 and 3 months post-stroke. Baseline data included demographics, co-morbidities, stroke subtype, pre-stroke disability and cognition. At baseline, 1- and 3-month interviews physical impairment, disability, cognition and social support were assessed. MDPS was defined as a score of >8 on the depression subscale of the Hospital Anxiety Depression Scale. Factors independently associated with MDPS at each time-point were determined using regression analyses., Results: One hundred and twenty-five subjects were included. The prevalence of MDPS within 5 days and at 1 and 3 months post-stroke was 5%, 16% and 21% respectively. The independent determinants for MDPS at 1 month were disability, social support and change in impairment score between initial and 1-month assessments; and at 3 months were disability, social support and institutionalisation. Individuals moved in and out of the subset of depressed patients over time. MDPS was independently associated with mortality at 3 months post-stroke., Conclusion: Mood disorder post-stroke increases in prevalence over the initial weeks post-stroke despite an improvement in disability, and is associated with mortality. Patients with MDPS at 1 month were not necessarily affected at 3 months and vice versa, indicating the dynamic nature of MDPS in the early stages.