Systemic disease in practice: Pontine haemorrhage and diplopia

A male patient (HJ, aged 75 in May 2012) was undertaking some DIY work at the front of the house while his wife left for her French class. She was away from 4pm and returned at 7pm to find blood stains in the hallway caused by her husband having suffered a broken nose. He remembered going outdoors, leaning against the ladder and feeling ‘peculiar’. He then remembered falling and losing consciousness. The fall had scratched his face. By the time his wife had arrived he had regained consciousness and had even told his wife that he ‘must have had a stroke.’ She immediately rang the ambulance service.