madhurima
AIPPG Experienced Senior Member
Joined: 06 Nov 2008
Posts: 1711
54948 Credits
|
 Posted: Mon Nov 02, 2009 2:18 pm Post subject: A 79 yo female brought to ER due to a suspected cerebrovascu |
|
|
A 79 yo female brought to ER due to a suspected cerebrovascular accident on her right side. She complains of diffuse paresthesia and tingling in her right hand. She did not loose consciousness. The physical exam reveals normal speech, symmetric deep tendon reflexes (2/4 on both upper limb, 2/4 both patellar reflex, 0/4 both achillies reflexes) and a cold right hand, and undetectable arterial radial pulse. Tinel and phalens sigh are negative. The rest of the examination is normal. What is the most appropriate next step in management of the patient?
a. CT of brain without contrast
b. MRI of brain with diffusion images
c. Doppler of carotid arteries
d. Schedule for EMG and nerve conduction studies
e. Immediate vascluar surgery consultation for intervention
|
|
madhurima
AIPPG Experienced Senior Member
Joined: 06 Nov 2008
Posts: 1711
54948 Credits
|
| Posted: Mon Nov 02, 2009 2:18 pm Post subject: |
|
|
Ans is E.
The patient presentation is typical for an embolus in her right upper extremity. Patient characteristically have a normal neurological exam with persisten signs of ongoing ischemia (e.g. paresthesias, change in temperature, and non-detectable radial arterial pulsation). Immediate anticoagulation with heparin and surgical intervention ( i.e embolectomy) are crucial to prevent tissue death (amputation) in a patient with ongoing ischemia of the limb.
(why not A and B), the patient's normal neurology exam makes the diagnosis of stroke unlikely.
Ok, if this patient did not have cold hand, and undectable pulse, what would be the diagnosis?(your opinions, just for my understanding), and is it CT or doppler of the carotid, if not doppler carotid of artery, when do we really have to choose that? Thanks.
|
|
