DOD- Neuro IC/CC 68 Y/o male presents to the ER with a 20 min episode of dysarthria, right facial drooping, and numbness, and right hand weakness. HPI: The patient's daughter claims that her father suddenly appeared "dazed" before this happened. Now the symptoms have completely resolved. He reports this happening a few weeks ago with some mono-ocular blindness. THe patient denies having headache , recent fall, fever, or loss of consciousness. He has a history of hypertension, Type 2 diabetes, and is a 20 pack year smoker/ recently quit. PE: VS: afebrile, BP 145/92, HR 72, RR 14. A bruit is heard over the left carotid artery. Cranial nerves II-XII appear intact on exam Language comprehension and speech are normal and the patient is alert and oriented X 3. His gait and grip are normal in the ED. LABS: CBC and Chem panel are normal with the exception of blood glucose 194. __ Translate the terms and give your educated opinion of what is going on with this patient. 1. What does dysarthrig mean and why is it concerning? 2. What is meant by Mono-Grular blindness and what things can it be indicative of? 3. Does the patient have high blood pressure in the ER. 4. Give 2 objective findings to support the patient most likely does not have an infection. 5. What is meant by the statement "alert and oriented times 3'' 6. Did the patient have a stroke? 7. Give your reasoning and if it was not a stroke, what other diagnosis may be fitting?

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DOD- Neuro IC/CC 68 Y/o male presents to the ER with a 20 min episode of dysarthria, right facial drooping, and numbness, and right hand weakness. HPI: The patient's daughter claims that her father suddenly appeared "dazed" before this happened. Now the symptoms have completely resolved. He reports this happening a few weeks ago with some mono-ocular blindness. THe patient denies having headache , recent fall, fever, or loss of consciousness. He has a history of hypertension, Type 2 diabetes, and is a 20 pack year smoker/ recently quit. PE: VS: afebrile, BP 145/92, HR 72, RR 14. A bruit is heard over the left carotid artery. Cranial nerves II-XII appear intact on exam Language comprehension and speech are normal and the patient is alert and oriented X 3. His gait and grip are normal in the ED. LABS: CBC and Chem panel are normal with the exception of blood glucose 194. __ Translate the terms and give your educated opinion of what is going on with this patient. 1. What does dysarthrig mean and why is it concerning? 2. What is meant by Mono-Grular blindness and what things can it be indicative of? 3. Does the patient have high blood pressure in the ER. 4. Give 2 objective findings to support the patient most likely does not have an infection. 5. What is meant by the statement "alert and oriented times 3'' 6. Did the patient have a stroke? 7. Give your reasoning and if it was not a stroke, what other diagnosis may be fitting?

Answer 1

1. Dysarthria refers to difficulty in speaking, which can be caused by problems in the nerves or muscles that control the mouth and throat. It is concerning because it could indicate a neurological issue, such as a stroke, which requires immediate medical attention.2. Mono-ocular blindness means blindness in one eye. It can be indicative of various conditions, including optic nerve damage, retinal detachment, or brain lesions affecting the visual pathway.3. Yes, the patient has high blood pressure in the ER, with a reading of 145/92 mmHg.4. Two objective findings that support the patient most likely does not have an infection are: - The patient is afebrile (no fever). - The patient denies having a recent fall, fever, or loss of consciousness.5. The statement "alert and oriented x 3" means that the patient is awake, aware of his surroundings, and can correctly identify person, place, and time.6. It is possible that the patient had a stroke, given the sudden onset of symptoms and their resolution within a short period. However, this needs further evaluation.7. The reasoning for a possible stroke is the sudden onset of symptoms, including dysarthria, facial drooping, and numbness in the right hand. These symptoms are classic signs of a stroke. If it was not a stroke, other diagnoses that may fit include a transient ischemic attack (TIA), which is a temporary blockage of blood flow to the brain. Other possibilities could include migraines with neurological symptoms or seizures.

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