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Vomiting & Sweating

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History of Present Illness:

  • A 52-year-old male presents to the ED for vomiting and generalized weakness for 12 hours straight.  He states while driving he suddenly started having generalized weakness and dizziness without vertigo or pain and multiple episodes of vomiting with no blood.  He also had sweating but no fever, or shortness of breath.  He also fell once, but did not hit his head.
  • He denies diarrhea, abdominal pain, headache  or other complaints.

Vital Signs & Physical Exam:

  • Vital signs are normal except for.
  • Physical exam is normal except for vomiting.  The abdomen is benign.  Cranial nerves and motor strength are normal.  There is no nystagmus.  The patient did not feel well enough to walk.

Initial Differential Diagnosis:

  • AGE
  • MI
  • Posterior CVA

Initial Diagnostic Testing:

  • CBC, GI labs and BMP are normal
  • The EKG is norma

QUESTIONS:

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

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ANSWERS:

  1. What should you do next?  Walk the patient and get a brain MRI.  He was a bit ataxic and the MRI showed two strokes.  One shown in the DWI series below
  2. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  3. 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: Acute infarct right cerebellum.

 

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