Posted April 27, 200915 yr We have a patient, 64 year old male admitted to the ER p/w sudden weakness to his upper and lower right limbs. On physical examination, the patient was unable to differentiate between two point touch, and could not determine directionality of his right upper and lower limbs when moved by the physician. The patient felt normal temperature and responded to pinprick sensation on the right side, but when tested on the left side, the patient showed no response to temperature or pinprick sensation. Physical examination showed flaccid paralysis of right upper and lower limbs. Plantar stroke reflex of the toe was extensor. Patient appears alert and oriented with no defects in turning the head in either direction. All other findings were normal in the patient. Differential Diagnosis?
April 27, 200915 yr We have a patient, 64 year old male admitted to the ER p/w sudden weakness to his upper and lower right limbs. On physical examination, the patient was unable to differentiate between two point touch, and could not determine directionality of his right upper and lower limbs when moved by the physician. The patient felt normal temperature and responded to pinprick sensation on the right side, but when tested on the left side, the patient showed no response to temperature or pinprick sensation. Physical examination showed flaccid paralysis of right upper and lower limbs. Plantar stroke reflex of the toe was extensor. Patient appears alert and oriented with no defects in turning the head in either direction. All other findings were normal in the patient. Differential Diagnosis? Sounds like a stroke... but maybe that's too easy. :wow:
April 28, 200915 yr Niggercock infestation? EDIT: But in all seriousness, Lateral Lupus Heart Worm Flu?
April 28, 200915 yr Author sp0rky;619111']Sounds like a stroke... but maybe that's too easy. :wow: Stroke is the cause, but where at? Also, what do we call this collection of symptoms? It has a specific name.
April 28, 200915 yr There could be a clot in the right basal ganglia. There should be something wrong with the spine. I am not quite sure what a pin prick test is but if the patient didn't have a twitch or a reflex it might be a similar problem with the spine. Edited April 28, 200915 yr by Player1
April 28, 200915 yr Author There could be a clot in the right basal ganglia. There should be something wrong with the spine. I am not quite sure what a pin prick test is but if the patient didn't have a twitch or a reflex it might be a similar problem with the spine. Basal ganglia is composed of gray matter in the brain. You can't have a clot in gray matter, only in the arteries that serve it. Also, if you had a clot in the arteries serving the basal ganglia, the patient would have severe muscular and sensory defects in the facial muscle and dermatomes. Spinal cord fits, but explain why, and what the constellation of symptoms is called.
April 28, 200915 yr I conclude that it is an ischemic stroke of the cerebral cortex. He should have his thrombus removed statim.
April 28, 200915 yr Basal ganglia is composed of gray matter in the brain. You can't have a clot in gray matter, only in the arteries that serve it. Also, if you had a clot in the arteries serving the basal ganglia, the patient would have severe muscular and sensory defects in the facial muscle and dermatomes. Spinal cord fits, but explain why, and what the constellation of symptoms is called. Lets get a CT scan and a MRI if the patient isn't getting worse. The spinal cord is like the lower order of the brain. It doesn't think but it controls twitches and reflexes. An example would be some idiot puts his hand on the stove, the sensory nerve goes to the spine and sends a motor signal to the muscle fibers to pull back. The reflex is an evolutionary miracle as it allow us to preform survival like tasks without having to cognitively think about it. Because the patient can't feel the prick that must mean there is a problem with the sensory neurons (unlikely because it might just be a small area) or with the actual grey matter. The problem has to be in a cervical vertebra 1-8 I am not sure that the constellation of symptoms is called. I am not a med student, just a really good anatomy student.
April 28, 200915 yr Author I conclude that it is an ischemic stroke of the cerebral cortex. He should have his thrombus removed statim. Stroke of the cerebral cortex that would cause these sort of defecits would involve yield a lot more symptoms such as sensory and motor defecits of the face and neck.
April 28, 200915 yr I conclude that it is an ischemic stroke of the cerebral cortex. He should have his thrombus removed statim. That is hard to believe. This man would have obvious signs of lower consciousness. It doesn't explain why he doesn't twitch unless the patient was sleep talking while he had he prick test.
April 28, 200915 yr Author Lets get a CT scan and a MRI if the patient isn't getting worse. The spinal cord is like the lower order of the brain. It doesn't think but it controls twitches and reflexes. An example would be some idiot puts his hand on the stove, the sensory nerve goes to the spine and sends a motor signal to the muscle fibers to pull back. The reflex is an evolutionary miracle as it allow us to preform survival like tasks without having to cognitively think about it. Because the patient can't feel the prick that must mean there is a problem with the sensory neurons (unlikely because it might just be a small area) or with the actual grey matter. The problem has to be in a cervical vertebra 1-8 I am not sure that the constellation of symptoms is called. I am not a med student, just a really good anatomy student. Good job with the cervical vertebrae. The name of this constellation of syndromes is probably not familiar to everyone. It's called Brown-Sequard Syndrome, which is a spinal cord lesion, either by tumor (unlikely due to it being rapid onset), physical injury, or ischemic stroke (most likely in this case). If you do a CT scan, you'd find a hypodense region on the right side of the spinal cord. T2 MRI would most likely present with a hyperintense region at the same location correlating to cytotoxic edema that usually follows an ischemic stroke. Needle prick is testing the pain and temperature sensory function. The way the spinal cord is organized is that two point distinction, proprioception, and touch sensation travels in the DWC of the ipsilateral spinal cord, while pain and temperature sensation travels contralaterally. That's why the patient could not feel pain on the left side of his body. EDIT: To be exact, it'd have to be at around C4 or above, as C5 and below contribute to sensory and motor function of the upper limb. Also, I told you guys this was a simple case. Edited April 28, 200915 yr by Dr. House
April 28, 200915 yr no one but dr. house knows anything about medicine so stfu and stop trying to look intelligent you retards i'm lookin at you player1
April 28, 200915 yr theMinkey;619142']no one but dr. house knows anything about medicine so stfu and stop trying to look intelligent you retards i'm lookin at you player1 whats all the foos aboot, eh?
