Clinical case studies Flashcards
Arnold, a 65 year old man, presents to his GP following an episode of sudden monocular blindness affecting the right eye. He described the visual loss like a black curtain falling over the eye, lasting 10 minutes before he regained normal vision. He reported no other signs at the time or since.
The GP suspects a transient ischaemic attack and arranges for some initial investigations, including an ECG
What does the ECG look like?
Atrial fibrillarion- causes clot formation= TIA
Arnold, a 65 year old man, presents to his GP following an episode of sudden monocular blindness affecting the right eye. He described the visual loss like a black curtain falling over the eye, lasting 10 minutes before he regained normal vision. He reported no other signs at the time or since.
The GP suspects a transient ischaemic attack and arranges for some initial investigations, including an ECG.
The patient is referred to secondary care for more investigations, including an ultrasound of the neck. Following the ultrasound scan that patient has an arteriogram of the blood vessels in his neck.
(i) What does the red arrow indicate?
(ii) What vessel in the neck does this relate to?
Atherosclerosis
Internal carotid artery
Arnold, a 65 year old man, presents to his GP following an episode of sudden monocular blindness affecting the right eye. He described the visual loss like a black curtain falling over the eye, lasting 10 minutes before he regained normal vision. He reported no other signs at the time or since.
The GP suspects a transient ischaemic attack and arranges for some initial investigations, including an ECG
Explain, with reference to your understanding of head and neck anatomy, how atherosclerotic disease within the internal carotid artery could have caused this man’s transient loss of vision
Internal carotid artery, runs through the neck, through the carotid canal, through the prevernous sinus, gives off opthalmic branch and central retinal artery, end artery so nothing else supplying=blindness
Arnold, a 65 year old man, presents to his GP following an episode of sudden monocular blindness affecting the right eye. He described the visual loss like a black curtain falling over the eye, lasting 10 minutes before he regained normal vision. He reported no other signs at the time or since.
The GP suspects a transient ischaemic attack and arranges for some initial investigations, including an ECG
Some months later…
Arnold is rushed to the Emergency Department with a sudden onset of weakness and numbness affecting the left side of his face and left upper limb
Other than motor weakness and paraesthesia involving the left half of Arnold’s face and left arm there are no other neurological signs found. The doctor suspects a stroke.
(i)
An area within which two lobes of Arnold’s brain has been affected by the stroke, and on which side?
Right frontal and parietal lobes
At what part of the central nervous system do the motor fibres arising from the primary motor cortex cross to the opposite side (decussate)?
Medulla
This is Arnolds head CT
What is structure A?
Why is it black?
Lateral ventricles
CSF is black as liquid and is within the cerebral cortex
A 45 year old woman is referred to a neurology outpatient clinic by her GP. Subsequent investigations reveals an intracranial tumour.
Within what part of the central nervous system is this tumour?
In which fossa is it located?
Cerebellum
Posterior cranial fossa
A 45 year old woman is referred to a neurology outpatient clinic by her GP. Subsequent investigations reveals an intracranial tumour.
After looking at the scan
What clinical signs could the woman have potentially
presented with and on which side of the body would these have been evident?
Right side of the body
co-ordination and motor learning diffculties
e.g. ataxic gaite, intention temor, dysdiadokinesis
