Mr G, a 65 year old right handed male, was found sprawled on the floor by his wi

Question

Mr G, a 65 year old right handed male, was found sprawled on the floor by his wife. When he woke, he appeared slightly confused and said something about everything looking blurry but couldn’t explain it well. He vaguely complained of a headache and a strange numbness in his right arm but his wife couldn’t make much sense of what he was trying to say. Mrs G said her husband was talking rapidly, but his words did not make any sense. She described it as if he was speaking meaningless words and irrelevant phrases. She was quite upset because it appeared that Mr G didn’t understand anything said to him and yet he seemed completely unaware of his condition. Mrs G noted that he was dragging his right arm and immediately called for an ambulance. Mr G has been a chronic smoker for the last 40 years and has a history of type 2 diabetes.

Physical examination: Vital signs: Temperature 38 C. Pulse=80. Blood pressure=150/100mmHg BMI=32 Head: Minor abrasions and mild bruising Heart: Regular rate, no murmurs Lungs: Clear Abdomen: Soft, normal bowel sound

Neurologic Examination: Mental status: Alert. Mildly agitated. Speech fluent, but with meaningless words and phrases. Unable to repeat words correctly. Spontaneous speech filled with made up words and jargon. Minor impairment in reading and writing.

Cranial nerves: Pupils equal, round and reactive to light. Extraocular movements were intact. Visual field testing showed difficulty in seeing objects on patient’s right side. Facial sensation intact to light touch and pinprick. Smile was symmetrical on both sides. No dysarthria. Motor: Slightly increased tone in the right arm. Normal tone on the left side. Moved all four limbs, but was unable to steadily hold right arm over head.

Reflexes: Mildly increased reflexes in the right arm. Coordination: Normal finger-to-nose and heel-to-shin test. Gait: Patient took small steps hesitatingly, was able to walk without support. Sensory: Temperature and light touch sensation intact on both sides. Decreased pinprick sensation on the right side. Graphesthesia and stereognosis normal in the left hand, absent in the right hand.

TASK: Using correct medical terms, list 10 key signs and symptoms in this case.

Explanation / Answer

Symptoms indicate that the patient has had TIA or transient ischemic attack or a mini stroke.This causes stroke like symptoms that resolves within 24 hours.

Unlike stroke TIA does not kill brain tissue. This happens when the brain lacks blood flow temporarily.

As the symptoms of Stroke and TIA are very similar immediate medical help must be sought.

Ten key signs:

1. TMB or temporary blindness in one eye.(A persons vision in one eye is suddenly dimmed.

2. Dysphasia. Speech problem like trouble saying or understanding a word.

3. Confusion like not understanding anything.

4. Balance issue. loosing balance or taking small steps.

5. An altered level of consciousness. Like in Mr. G 's case using irrelevent phrases and words, not understanding anything and still being unaware of it.

6. Passing out.

7. Tingling pins and needles or reduced sensation of touch.

8. Weakness or numbness on just one side of the body or face. (determined by the location of the blood clot)

9. Dizziness.

10. Abnormal sense of smell and taste.

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