Mr G, a 65 year old right handed male, was found sprawled on the floor by his wife. When he woke, he appeared slightly confused and said something about everything looking blurry but couldnât explain it well. He vaguely complained of a headache and a strange numbness in his right arm but his wife couldnât make much sense of what he was trying to say. Mrs G said her husband was talking rapidly, but his words did not make any sense. She described it as if he was speaking meaningless words and irrelevant phrases. She was quite upset because it appeared that Mr G didnât understand anything said to him and yet he seemed completely unaware of his condition. Mrs G noted that he was dragging his right arm and immediately called for an ambulance.
Mr G has been a chronic smoker for the last 40 years and has a history of type 2 diabetes.
Physical examination:
Vital signs: Temperature 38 ËC. Pulse=80. Blood pressure=150/100mmHg
BMI=32
Head: Minor abrasions and mild bruising
Heart: Regular rate, no murmurs
Lungs: Clear
Abdomen: Soft, normal bowel sound
Neurologic Examination:
Mental status: Alert. Mildly agitated. Speech fluent, but with meaningless words and phrases. Unable to repeat words correctly. Spontaneous speech filled with made up words and jargon. Minor impairment in reading and writing.
Cranial nerves: Pupils equal, round and reactive to light. Extraocular movements were intact. Visual field testing showed difficulty in seeing objects on patientâs right side. Facial sensation intact to light touch and pinprick. Smile was symmetrical on both sides. No dysarthria.
BMSC12007
Motor: Slightly increased tone in the right arm. Normal tone on the left side. Moved all four limbs, but was unable to steadily hold right arm over head.
Reflexes: Mildly increased reflexes in the right arm.
Coordination: Normal finger-to-nose and heel-to-shin test.
Gait: Patient took small steps hesitatingly, was able to walk without support.
Sensory: Temperature and light touch sensation intact on both sides. Decreased pinprick sensation on the right side. Graphesthesia and stereognosis normal in the left hand, absent in the right hand.
(Given the signs and symptoms above it strong suggest transient ischemic attack (TIA))
TASK: Discuss a most likely diagnosis for Mr Gâs condition (TIA) by discussing risk factors and underlying pathophysiology. What can be other possible differential diagnosis? Support your answer with reasoning.
Mr G, a 65 year old right handed male, was found sprawled on the floor by his wife. When he woke, he appeared slightly confused and said something about everything looking blurry but couldnât explain it well. He vaguely complained of a headache and a strange numbness in his right arm but his wife couldnât make much sense of what he was trying to say. Mrs G said her husband was talking rapidly, but his words did not make any sense. She described it as if he was speaking meaningless words and irrelevant phrases. She was quite upset because it appeared that Mr G didnât understand anything said to him and yet he seemed completely unaware of his condition. Mrs G noted that he was dragging his right arm and immediately called for an ambulance.
Mr G has been a chronic smoker for the last 40 years and has a history of type 2 diabetes.
Physical examination:
Vital signs: Temperature 38 ËC. Pulse=80. Blood pressure=150/100mmHg
BMI=32
Head: Minor abrasions and mild bruising
Heart: Regular rate, no murmurs
Lungs: Clear
Abdomen: Soft, normal bowel sound
Neurologic Examination:
Mental status: Alert. Mildly agitated. Speech fluent, but with meaningless words and phrases. Unable to repeat words correctly. Spontaneous speech filled with made up words and jargon. Minor impairment in reading and writing.
Cranial nerves: Pupils equal, round and reactive to light. Extraocular movements were intact. Visual field testing showed difficulty in seeing objects on patientâs right side. Facial sensation intact to light touch and pinprick. Smile was symmetrical on both sides. No dysarthria.
BMSC12007
Motor: Slightly increased tone in the right arm. Normal tone on the left side. Moved all four limbs, but was unable to steadily hold right arm over head.
Reflexes: Mildly increased reflexes in the right arm.
Coordination: Normal finger-to-nose and heel-to-shin test.
Gait: Patient took small steps hesitatingly, was able to walk without support.
Sensory: Temperature and light touch sensation intact on both sides. Decreased pinprick sensation on the right side. Graphesthesia and stereognosis normal in the left hand, absent in the right hand.
(Given the signs and symptoms above it strong suggest transient ischemic attack (TIA))
TASK: Discuss a most likely diagnosis for Mr Gâs condition (TIA) by discussing risk factors and underlying pathophysiology. What can be other possible differential diagnosis? Support your answer with reasoning.
