question archive This is a case scenario from the book Neuroanatomy through clinical cases BY Blumenfeld SUDDEN ONSET OF RIGHT-HAND WEAKNESS CHIEF COMPLAINT A 64-year-old man developed right-hand weakness following cardiac arrest
This is a case scenario from the book Neuroanatomy through clinical cases BY Blumenfeld SUDDEN ONSET OF RIGHT-HAND WEAKNESS CHIEF COMPLAINT A 64-year-old man developed right-hand weakness following cardiac arrest
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This is a case scenario from the book Neuroanatomy through clinical cases BY Blumenfeld
SUDDEN ONSET OF RIGHT-HAND WEAKNESS
CHIEF COMPLAINT A 64-year-old man developed right-hand weakness following cardiac arrest. HISTORY The patient had a history of hypertension and cigarette use but was otherwise healthy until the admission day when he suddenly collapsed in church. Family members at the scene administered immediate CPR, and when the ambulance arrived, the patient received electrical defibrillation and promptly regained a normal cardiac rhythm. He was admitted to the cardiac intensive care unit and had rapid atrial fibrillation episodes. Several days after admission, he was noted to have the right hand's weakness, and a neurology consult was requested. PHYSICAL EXAMINATION Vital signs: T = 98°F, P = 100, BP = 130/60. Neck: Supple with no bruits. Lungs: Clear. Heart: Irregular rhythm, with a soft systolic murmur. Abdomen: Normal bowel sounds; soft, non-tender. Extremities: Normal. Neurologic exam: MENTAL STATUS: Alert and oriented × 3. Language is fluent, with intact naming, repetition, and reading. Able to recall 3/3 objects after 5 minutes.
CRANIAL NERVES: Normal, including no facial weakness.
MOTOR: Power 5/5 throughout, except for right hand and wrist: Right wrist flexion, extension, and handgrip 3/5. Right finger extension, abduction, adduction, and thumb opposition 0/5. REFLEXES:
2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+
COORDINATION AND GAIT: Not tested.
SENSORY: Intact light touch, pinprick, joint position, and vibration sense. No extinction on double simultaneous stimulation.
Please help me in answering the following questions
1) How would you discuss your assessment and provide the neuroimaging studies with rationale for each study
2) What are the key symptoms that you identified from your assessment that led to evaluation of this case?
3) Do you see any unusual features meaning signs , symptoms that can lead to another study or differential diagnosis?
