Managing a Simulated Case

It's our first blog post for 2020, and for a while. This complements the Youtube video and Google quiz of the above title.

So, lets break it down!

An elderly gentleman comes in to hospital with an acute problem- he's having dizziness (of a vertigo pattern), and he also has difficulty speaking and swallowing.

Has he had a stroke?

Well, he's diabetic and hypertensive (likely poorly controlled as he hasn't had recent follow-up), and has a 40 pack year history of cigarettes.

His BP is elevated, and his pulse is regular.

You immediately notice a few things:

Ptosis of right eye.

Right sided ataxia.

No limb weakness, no altered sensation.

Examination otherwise acceptable, he's well oriented and has a GCS of 15/15.

What do you suspect?

Putting it together, there's a ipsilateral Horner's syndrome, vertigo, ipsilateral ataxia with no weakness.

Suspicious of Wallenberg's syndrome right?

What tests would you order?

Immediate CT is appropriate, but MRI will find the cause- a PICA territory lesion, of the vertebral artery.

He doesn't need an EEG or an LP or anything of that nature.

What is the next step?

He needs his BP and RBS managed. He needs dual antiplatelet therapy. He needs a high dose statin. He would also benefit from Speech and Language therapy, Occupational therapy, and an ECHO, Holter and Carotid Doppler- to assess his heart and neck for clearance.

Here are the necessary links, and thanks for reading!

Specific Links:

Quiz: https://docs.google.com/forms/d/e/1FAIpQLSeK3gfVkP2xCFr72TxlWMQJTtTF0HbnV5W5sRuaSzN4gNBjHQ/viewform?usp=sf_link

Video: https://youtu.be/yeWQl3vO-lo