Endocrine Case Report: Insomnia After Transient Ischemic Attack

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This endocrine case report features a patient in their mid-50s with a history of recent TIA presenting to the hospital with increasing anxiety and insomnia over the past week. Can you determine the correct diagnosis?

History of Present Illness:

A patient in their mid-50’s presents to the hospital with increasing anxiety and insomnia over the past week. He reports anxiety for 1 year however over the past 3 months it has progressively worsened, especially over the past week and now is unbearable. He reports he wakes up in the middle of the night in complete panic and has to go outside for a walk. He notes the anxiety is exacerbated when the sun goes down as he becomes extremely anxious that he won’t be able to sleep. Another stressor is a recent TIA where he had left sided weakness and was admitted with a negative workup. He has been taking Benadryl for insomnia but it is not providing much relief.

Vital Signs & Physical Exam:

Vital signs are normal. Physical exam is also normal except for elevated BP and a very anxious patient

Initial Diagnostic Testing:

CBC: normal except for Hb/Hct of 21/63

Chem-7: normal

TSH: normal

Imaging: none

What additional history could be useful in this case?


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