Weakness and Dizziness
Answers
345.The answer is d.(Rosen, p 1435.)The patient had a TIA,which
involvesneurologic deficits that resolve within 24 hours of onset.TIAs
often precede ischemic stroke; up to 50% of patients with a TIA will have
a stroke in the next 5 years, with the highest incidence in the first month.
It is important to recognize TIAs and to evaluate patients for cardiac or
carotid arterial sources of emboli.Although the symptoms often resolve,
many patients with a TIA will have evidence of infarction on CT/MRI.
The patient did not have a thrombotic (a)stroke. Neurologic deficits are
not transient in a cerebral vascular accident. Conversion disorder (b)is a rare
disorder that is characterized by the abrupt, dramatic onset of a single symp-
tom. It typically presents as some nonpainful neurologic disorder for which
there is no objective data. It is a diagnosis of exclusion. Although migraine
auras can include focal neurologic deficits (c), the patient in the vignette does
not have a history of migraines and is not complaining of a headache. Todd
paralysis(e)is a transient focal neurologic deficit that persists after a seizure.
346.The answer is a.(Tintinalli et al, p 1404.)BPVis a transient positional
vertigo associated with nystagmus. The problem occurs secondary to the
creation and movement of canaliths (free-moving densities) in the semicircular
canals of the inner ear with a particular head movement. Neurologic deficits
are absent in BPV. Note that horizontal, vertical, or rotary nystagmuscan
occur in BPV. It is important to pay special attention to a patient with vertical
nystagmus because it may be associated with a brainstem or cerebellum
lesion. BPV is treated with the Epley maneuver(a series of head and body
turns that reposition the canalith), antiemetics, and antihistamines. Key
differences between peripheral and central vertigo are seen in the chart.
Food poisoning (b)would not cause vertigo. If it is associated with
vomiting and diarrhea, it can lead to dehydration and lightheadedness but
not vertiginous symptoms. Meniere disease (c), is an inner ear disease of
unclear etiology. It presents with recurrent attacks of vertigo and tinnitus,
with deafness of the involved ear between attacks. Labyrinthitis (d)presents
with hearing loss and sudden, brief positional vertigo attacks. TIAs (e)involving
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