d******a
发帖数: 127 | 1 85 yo WM w/no significant PMH presented in ER for AMS. CC: I can't move my
right leg between the pedals and don't feel good. His wife stated that he
has been pretty healthy and still drives everyday. ER CT w/o contrast was
negative. Vitals: NL; PE: Nothing significant. Patient had Brain MRI which
showed multiple small lesions B/L in the basal ganglia. What is the
diagnosis? | l*********e
发帖数: 158 | 2 I am a vegetable bird, so I don't care to google and guess and be totally
wrong.
"When confronted with a MRI pattern showing bilateral basal
ganglia lesions, the differential diagnosis includes hypoxic injury
[6], mitochondrial disease [7], vasculitis [8], carbon monoxide
intoxication [9], hypoglycemia [10], extrapontinemyelinolysis [11],
Wilson’s disease [12], Creutzfeldt–Jakob disease [13], and deep
venous thrombosis [14]."
So I guess deep venous thrombosis, and I guess lacunar stroke.
http:// | d******a
发帖数: 127 | 3 >>>"When confronted with a MRI pattern showing bilateral basal
ganglia lesions, the differential diagnosis includes hypoxic injury
[6], mitochondrial disease [7], vasculitis [8], carbon monoxide
intoxication [9], hypoglycemia [10], extrapontinemyelinolysis [11],
Wilson’s disease [12], Creutzfeldt–Jakob disease [13], and deep
venous thrombosis [14]."
Very nice! What is the diagnosis?
As a physician, the most important thing is that you try to get the history
and do physical by yourself. | l*********e
发帖数: 158 | 4 I guess; Sitting - Deep Venous Thrombosis in the lower limb -Patent foramen
ovale- stroke in deep penetrating arteries that arises directly from the
constituents of the Circle of Willis, cerebellar arteries, and basilar
artery that irrigate posterior limb of the internal capsule-descending
corticospinal tracts- hemiplegia? How can the bilateral lesions happen with
one side of symptoms? | m********a
发帖数: 8 | 5 What is the result of physical?
Could it be that he dependes on right leg for driving, so he feels the
problem is only on the right leg? | m********a
发帖数: 8 | 6 Looking forward to the answers. | n*******c
发帖数: 501 | 7 Thanks for sharing this interesting case.
May I ask for how long he has had this problem? Has he had problems with
walking or going up and down stairs? Any pins and needles sensation on right
leg?
A detailed history and neurological exam is warranted.
If his walking is mostly fine (it seems to be so if he manages daily life
well although detailed Neuro Exam is needed) but only complains difficulties
with pedals, then probably it is more a coordination/position sense problem
rather than weakness. | d******a
发帖数: 127 | 8 lotusconnie got the answer based on "a MRI pattern showing bilateral basal
ganglia lesions".
His wife stated that he has been pretty healthy and still drives everyday.
It is unusual that a 85 yo male drives daily. When we asked more details, pt
's wife states that her husband loved driving so much and he was driving his
car hours everyday for fun. But his a was an very old 1980's car. After
further investigation, this patient suffered from chronic carbon monoxide
poisoning. This is a very unique |
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