Authors: Sian Juniper / Editor: Steve Corry-Bass / Reviewer: William Gibbs / Codes: CC2, NeuC12, NeuP4, NeuP8, SLO1 / Published: 31/07/2022
A 75-year-old man presented to the Emergency Department (ED) with his wife claiming that he ‘just doesn’t feel right’, this morning he kept dropping the soap in the shower, and then knocked over his tea because he did not realise it was next to him. He felt fine when he first woke up and did not have any problems making his breakfast.
This happened about 2 hours ago.
He is worried because his arms and legs feel heavy, uncomfortable and this has never happened before. His wife said his voice also sounds unusual although the patient himself claims that he hears no difference.
He is usually very fit, and prefers walking to driving.
He is normally on atorvastatin for high cholesterol that is well controlled. He smoked between the ages of 15 to 55 but after seeing advertisements about the dangers of smoking he completely quit.
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Question 1 of 6
1. Question
Which structure should you use to assess this patient in the ED?
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Question 2 of 6
2. Question
On examination of the patient, you discover that although he can talk to you and maintain his airway, he is slightly slurring his words. He is unable to grip your fingers strongly with the left hand and claims his left leg feels heavy and is struggling to move it.
What bedside test is important now?
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Question 3 of 6
3. Question
What other bedside examination would be most appropriate here?
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Question 4 of 6
4. Question
You discover that the patient has a left sided homonymous hemianopia, as well as weakness in the facial nerve and reduced sensation on the left side of his face.
What is the most likely diagnosis here?
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Question 5 of 6
5. Question
What immediate management is suitable here?
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Question 6 of 6
6. Question
What is important to consider in the management plan going forward?
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