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I hear an echo

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 62-year-old female with a history of HTN and DM presents to the ED for her voice sounding like it is echoing in her head when she talks for the last 2 days associated with constant mild left leg numbness but no weakness. She denies any trouble with vision or speech, headache or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for BP of 198/110.  Physical exam is notable for an accent and diminished subjective sensation to the left leg.

Initial Differential Diagnosis:

  • Stroke
  • Ear wax
  • Anxiety

Initial Diagnostic Testing:

  • EKG: normal
  • Labs: glucose 315, otherwise unremarkable
  • Imaging: see below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  SMALL RECENT INFARCTION OF RIGHT UPPER/MID PONS. POSSIBLE FEW MICROHEMORRHAGES.
  2. What should you do next?  Consult neurology and admit.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Admitted.  Symptoms mostly resolved by discharge home 3 days later.

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