Case Study 3
Male patient, 45 years old, married and resident of Espita. Labora driving a tricycle, of lower socioeconomic status and history of weekly alcohol intake.
Starts a month earlier with moderate headache intensity, oppressive, and holocraneana than last week added nausea. During this last week has left pelvic limb paresthesias lasting for 2 minutes and then noticing discrete limb movement, such as continuous, rhythmic shaking of a 2 minutes.
These crises are repeated throughout the day, gradually more frequent during the day and more intense. One day before admission note that post-crisis movement has difficulty walking because of decreased strength of the same, entering as the movement is generalized to the entire left hemisphere and becoming steadily over the past hours.
A physical examination is the patient with normal vital signs, weight of 65 kilos and height of 1.55m. Its normal general examination.
Neurologic examination: normal FMS, cranial nerves unaltered even fundus. Continuous movement is observed left hemisphere, clonic, rhythmic; myotatic reflexes 4 / 4 of the left hemisphere and right ¾. Babinsky left. Normal sensation. No neck stiffness or meningeal signs.
Skull CT was performed and lesions are rounded, well-demarcated, hypodense with ring enhancement to the contrast and moderate edema, a right frontoparietal region located at about 30mm with small hyperdense image inside, near interhemispheric fissure, and another 8 mm in the left frontal region at the convexity and a more than 5 mm at the right time. Normal ventricular system.
WORKING GUIDE
This workbook is based on contrasting two options besides proposing diagnostic imaging and treatment by EEG. In each statement write your arguments:
1. Abnormal movement against seizure (described movements)
2. What do abnormal movement or seizure (described movements)
3. Hemiparesis as targeting against Todd phenomenon (decrease of force reported by the patient one day before)
4. Paresthesias with normal sensitivity relating to exploration busy explaining an injury or a destructive lesion (Bend down one and why)
5. Toxoplasmosis against metastasis (Diagnostic Imaging)
6. Tuberculomas against cysticercosis (Diagnostic full picture)
Now lists the following and do not forget to write down your arguments:
7. What you expect to find on EEG
8. What would indicate to management control of the movements of this patient
9. What management would indicate the likely pathology
10. What forecasts issued in this case