HPI
A 75-year-old patient presents to her primary care physician complaining of a sudden inability to stand up. She notes visual problems but has difficulty being more specific and also notes hoarseness and difficulty swallowing.
PMH
HTN
Medications: Enalapril
PE
NEURO
- MS: Normal
- CN: Coarse rotolateral nystagmus with gaze to the right and there is right facial numbness. The right side of the soft palate does not elevate with stimulation.
- Sensation: Pin and temperature are reduced on the left side of the body and vibration and proprioception are intact throughout.
- Motor/Cerebellar: Gait is very wide based and when feet are placed together the patient falls backward and to the right. There is no appendicular ataxia.
Study Questions:
- What are the important features about here history?
- What are the important features about his examination?
- What neurological system(s) is(are) most likely affected?
- What pathophysiological processes could affect these neurological systems?
- What testing (anatomical, functional, or biochemical) could be ordered to test #3 and #4.
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Her physician orders a carotid ultrasound, which reveals a right internal carotid artery occlusion.
Additional questions:
- Are the carotid ultrasound findings directly or indirectly related to her presentation?
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