History of Present Illness:
A man in his early 80’s presents to the ED for bilateral leg weakness without any neck or back pain or headache. He states he is able to walk but is having new difficulty for the past week and has not improved. He also states that his tongue has felt/tasted funny for about a week as well. He also states his lips feel a little weak, but denies any change in speech, vision or balance.
Vitals & Physical Exam:
Vital signs are normal. Exam is normal except for a slow steady gait and 5-/5 bilateral leg strength. Reflexes are normal and there is no clonus.
Differential Diagnosis:
- Cord compression
- Generalized weakness
- Brainstem CVA
- Myopathy
Initial Testing:
- CBC and BMP normal.
- MRI shown below.
QUESTIONS:
What is the most likely diagnosis?
- A) CVA
- B) Encephalitis
- C) Cerebral venous thrombosis
- D) None of the above
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ANSWERS:
- A) CVA – CORRECT – there is a stroke in the left pons
- B) Encephalitis
- C) Cerebral venous thrombosis
- D) None of the above
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CASE CONCLUSION: Had asymmetric vertebral arteries but no dissection. The rest of the stroke w/u was negative. Plavix was added to the aspirin he was already taking