April 28, 2009

weakness that resolves after arriving at ER

A 67-year-old man presents with an episode of right face, arm, and leg weakness that resolved on arrival to the emergency room. [Taken and Modified from Question 390, Physical Diagnosis Pretest® Self-Assessment and Review Fourth Editio, Jo-Ann Reteguiz, M.D., Beverly Cornel-Avendaño, M.D, Mcgraw-Hill Medical Publishing Division Pretest® Series]

1)What is the most likely diagnosis?

-Transcient Ischaemic attack
** Episodes of focal neurological symptoms due to inadequate blood supply to the brain. Attack is sudden in onset, resolve within 24 hours. The attack is important as a warning or precursor to cerebral infarction.

2)Outline the pathophysiology

-Reduced flow through vessel
** A fall in perfusion pressure
** Eg: Cardiac dysarhytmia associated with localized cerebrovascular disease
** Hemodynamic explaination

-Blockage of the passage of flow by embolism
** Arising from plagues in aortic arch/ extracranial vessel or from the hearts.
** Embolic explaination

3)What other history that you would like to ask
-Prolong travel (risk of deep vein thrombosis)

-Any cardiac disease
a)Vulvular heart disease
b)Ischaemic heart disease
d)Bacterial endocarditis

-Using of prosthetic joint or device (emboli)
-Any malignant or tumor disease
-History of fracture (fat emboli)

4)What is the drug of choice
-Anticoagulant (Heparin, warfarin)

Generations before you We destroyed when they did wrong: their messengers came to them with clear-signs, but they would not believe! thus do We requite those who sin! [Q10:13]

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