Authors: Philip Kaye, Andrew Smith / Editor: Jason Kendall Reviewer: Jolene Rosario, Phil Delbridge / Codes: NeuC12, NeuP8, NeuP9, SLO1 / Published: 27/10/2023
A 69-year-old man presents to the Emergency Department (ED) after a minor road traffic accident. The patient describes suddenly becoming unwell whilst driving his car. He was unable to control the car and it veered onto a grass verge at low speed. The car was undamaged. His uninjured passenger confirmed this account. The police attended and the man was noted to have slurred speech and an unsteady gait. He was breathalysed due to suspicion that he was intoxicated with alcohol but this was negative.
The emergency medical services were contacted and at scene were concerned about an acute neurological problem having precipitated the crash. He was transferred to the ED with a pre-alert concerning a positive FAST (face-arm-speech test) due to the speech disturbance.
The patient has no significant past medical history and no previous episodes of this complaint has been identified. On arrival, primary ATLS assessment demonstrates no major injuries. On secondary survey he is noted to have a bilateral acute cerebellar syndrome with significant disturbance of speech and gait but no evidence of external injury. His admission NIHSS score is 3 (2 for ataxia and 1 for mild dysarthria).