Emmanuelle is a 70 year old, recently retired solicitor who presents with fatigue and depressed mood. He has no associated features of depression.

He dates the onset of his symptoms from a minor CVA two months before which presented as mild right hemiparesis. A CT scan at the time showed an ischemic stroke in the territory of the left middle cerebral artery. He was commenced on aspirin and his right hemiparesis resolved completely after 2 days. He has had no recurrence.

Emmanuelle has hypertension, which is well controlled on an ACE inhibitor. He lives with his wife, who is in good health. He has three daughters who live close by and visits frequently with his grandchildren. He has been a smoker 20-30 /day in the past, but gave up 10 years ago when he developed hypertension. He drinks 20 grams of alcohol per day as red wine.

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