Week 3 Answers and Lectures
Case 1
Diagnosis: MULTIPLE SCLEROSIS
The keys to this case are:
- She has had two events separated by at least one month lasting at least 24 hours.
- Young females are the biggest risk group.
- The asymmetric reflexes with spasticity point to a structural problem in the CNS.
- The MRI is classic for MS.
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Case 3
Diagnosis: LACUNAR STROKE
The keys to this case are:
- Dysarthria and hemiparesis localize to the brain or brain stem.
- Sudden onset disease suggests stroke.
- No vision change, cognitive deficit, or aphasia suggests that this is not a large cortical stroke. Rather, the features point to something subcortical such as the internal capsule or pons.
- She has several stroke risk factors.
- It is easy to focus on the carotid stenosis, but remember your anatomy. The carotid does not supply the brainstem, the vertebrobasilar does. Lacunar disease is local thrombosis in small vessels most often.