![]() CT angiogram, echocardiogram and thyroid function test results were all normal and she had no previous history of depression or dementia. A computed tomography (CT) scan at this time showed a hypodensity in the right anterior commissure, although it could not be confirmed whether this represented a lacunar infarct or a perivascular space. She had been admitted to the stroke unit and treated with ongoing clopidogrel. She had particularly noted difficulty in remembering names and registering information (both written and aural), headaches and cerebellar signs (ataxia and dysdiadochokinesis). The cerebrovascular episode had occurred in July 2010, when the patient experienced symptoms consistent with a stroke: dizziness, disorientation, nausea, vomiting and being “off balance on the left side”. Her serum cobalt level was 410 nmol/L (reference range, 0–20 nmol/L) and chromium level was 240 nmol/L (reference range, 0–100 nmol/L). X-rays showed a well fixed, well aligned implant, with mild osteopaenia around the acetabular component. She had mild groin pain but otherwise no symptoms related to her hip. She also had a continuous metal taste in her mouth and complained of severe headaches, anorexia and weight loss. ![]() ![]() At review, she had neurological symptoms, including cognitive decline, memory difficulties and depression, which had been present for 7 months since a cerebrovascular episode. Statistics,epidemiology and research designĪ 73-year-old woman presented to our orthopaedic clinic in February 2011 for follow-up of a right total hip replacement that had been performed 5 years previously because of osteoarthritis.Statistics, epidemiology and research design. ![]()
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