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Rash in an elderly woman presenting with collapse.

Accepted 3 January 1996 An 87-year-old woman was brought to the Accident and Emergency department with a history of sudden loss of consciousness. On examination she was confused and had Glasgow Coma Scale of 9. She was hypothermic (35°C), normotensive, in sinus rhythm and had a left hemiparesis. Her initial investigations, including chest X-ray and an electrocardiogram (ECG) were normal. After her transfer to the admitting ward her Glasgow Coma Scale improved to 14. On the following day she suddenly became pale and hypotensive and a cardiac monitor showed bradycardia with sinus arrest. She responded to resuscitation. Over the next 24 hours her left hemiparesis resolved completely but she became oliguric and developed bruising in both flanks. A further ECG showed ST segment depression in the inferior limb leads. Her blood tests revealed mild anaemia, abnormal clotting profile, impaired renal function and raised cardiac enzymes. Serum and urinary amylase were normal. Fresh frozen plasma was given and her urinary output improved with diuretics. Her clotting profile and renal function improved. Her condition remained stable for the next two days but on the fifth day of her admission she suffered a cardiac arrest and died.