MEDICINE Patient SCENARIO: and I need 5 hypothesis of what could be causing this
ID: 98421 • Letter: M
Question
MEDICINE Patient SCENARIO: and I need 5 hypothesis of what could be causing this symptoms. If you can attach a link or explain the reason of what you got to that conclusion of hypothesis will be helpful. Thanks
Scenario Mr George Foreman is a 75 year old retired cook who lives with his wife. Over the last few months prior to his presentation to the emergency room, he had been having episodes where he experienced a few minutes of loss of vision "like a black curtain coming down" of his left eye. On the day of presentation, his wife found him slumped over the breakfast table. He was unable to speak, but seemed to understand what she was saying. The right side of his face was drooping and his right arm was weak. He arrived at the emergency room 2 hours after the onset of his symptoms. On examination, he is unable to speak but obeys simple commands. There is a right facial droop, more pronounced in the lower part of the face. Vision and visual fields are intact. Power is reduced in the right arm, with only weak elevation of the shoulder and shoulder adduction. There is mild weakness of right hip flexion. Plantar responses are flexor. There is a soft bruit on auscultation of the left carotid artery. Vital signs show a blood pressure of 165/100. .His medical history includes hypertension, for which he has been on treatment with an ACE inhibitor. He is an ex-smoker, having smoked 20 cigarettes a day for 40 years; he last smoked 10 years ago. His father, who was also a smoker, died of a stroke at the age of 65 Haematological and biochemical screen are normal, including a blood sugar. gulation screen is normal. CT scan of the brain performed shortly after arrival at Coa the hospital is reported as normal in the an scan . MRI scan shows an area of diffusion restriction terior portion of the left middle cerebral artery territory, and a repeat CT done 48 hours later shows an area of low attenuation in the same region.Explanation / Answer
Transient Ischemic Attack
The symptoms shown by Mr. Foreman shows the signs of Transient Ischemic attack in which a temporary stroke is experience by the patient and recovers on its own after few minutes during the attack the person is not able to speak called as aphasia, movement of body is affected and the persons may experience confusion which makes decision taking capacity difficult.
During this is stroke only one side of brain is affected and signs may be limited to one side impairing vision, speech, hand and leg movements
Amaurosis Fugax is a specific type of TIA s a temporary loss of vision in one or both eyes due to a lack of blood One cause is when a blood clot or a piece of plaque blocks an artery in the eye. The blood clot or plaque usually travels from a larger artery, such as the carotid artery in the neck or an artery in the heart, to an artery in the eye. These plaques are a hard substance that forms when fat, cholesterol, and other substances build up in the walls of arteries generally seen with persons with history of heart disease, alcohol abuse, cocaine uses, aged persons, smoking, hypertension and family history. It may also caused by other disorders like brain tumor, head injury, Migraine headaches and other eye problems
In the case of Mr. Foreman, showed the symptoms o floss of vision for short period of time with impaired body movement s of one side inability to speak and follow commands and his CT scan reports also showed attenuation In cerebral artery with all these symptoms and past history of hypertension and smoking habits we can say that he got stroke of Amaurosis Fugax.
The treatment includes quitting of smoking at the first instance, following healthy diet with proper exercises and with proper medications for control of blood sugar and blood pressure has proven to shown fast and speedy recovery.
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