HPI
72-year-old RH woman is brought to the ER by her family with sudden onset of left sided weakness. She denies that anything is wrong.and one occasion where he lost vision for 2 minutes.
PE
- General Exam: NAD BP 200/95
- The rest of the general examination is normal.
NEURO
- MS: Somnolent but easily arousable. She speaks fluently and correctly, follows simple directions but reads only the right half of sentences and bisects lines to the right of midline.
- CN: left homonymous hemianopsia, inability to move the eyes fully to the left, left lower facial weakness.
- Motor: severe weakness of the left upper and lower extremity, normal on the right
- Sensory: impaired to all modalities in the left upper extremity and slightly in the left lower extremity, normal on the right.
Study Questions:
- Summarize the history and physical exam findings.
- What is the importance of the patient’s reading difficulties?
- Why is the patient denying that anything is wrong with her?
- Localize the lesion.
- What pathophysiology do you suspect?
- What diagnostic studies would you request and what do you expect to find?
- If you are called that the patient is now comatose, what do you suspect has happened?
- What would you request at that point?
- If the patient was 25, are there other diagnostic tests that you would have requested?
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