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new neurology case by Al Durra


new neurology case by Al Durra


حالة سريرية

الوصف الكامل Background

A successful 48-year old attorney was told he was hypertensive, but did not take his blood pressure medications. He was apparently well until 4 days after his birthday, when he developed several episodes of blurred vision, "like a shade coming down," involving his left eye. These attacks each lasted less than an hour. He was referred for neurologic evaluation but because of a busy schedule, canceled the appointment. Several weeks later, he complained to his wife of a left-sided headache. She found him 1/2 hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurologic examination in the hospital revealed total paralysis of the right arm and severe weakness of the right face. The leg was only mildly affected. Deep tendon reflexes were initially depressed on the right side, but within several days, became hyperactive; there was Babinsky response on the right. The patient was globally aphasic; he was unable to produce any intelligible speech and appeared to understand only very simple phrases. A CT scan revealed an infarct in the territory of the middle cerebral artery of the left side. Angiography revealed occlusion of the internal carotid artery. The patient recovered only minimally.

كتابة حرة وطرح موضوع النقاش!

What was the cause of the several episodes of blurred vision

The CT scan showed that the infarct included the territory of the middle cerebral artery but the occlusion involved the internal carotid artery. Why was the territory of the anterior cerebral artery not infarcted?

I chose an easy case this time , just to make sure that everyone knows the basics

Al Durra's picture
by
بعد التخرج



Quote:
What was the cause of the several episodes of blurred vision

I think because of AION (Anterior Ischemic Optic Neuropathy

Quote:
The CT scan showed that the infarct included the territory of the middle cerebral artery but the occlusion involved the internal carotid artery. Why was the territory of the anterior cerebral artery not infarcted

because of anterior communicating artery

gardeania's picture
gardeania
بعد التخرج

first... you know that the first branch of the internal carotid artery is the ophthalmic artery so any stenosis or occlusion in internal carotid will affect on ophthalmic artery first .... so this several episodes of blurred vision were alarmig signs of the occlusion of the internal carotid...

second ... because of the presence of anterior communiting artery which compenste the ischimic problem in the left anterior cerebral artery ... while MCA doesnt have this advantage...

SALAM

marabd's picture
marabd


thank you both
your answers are correct , but i meant in the first question naming more specificaliy what happened to him

the several episodes of blurred vision were due to what we call TIAs

this term is very important and should always raise our suspicion to detect and treat every patient suffers from them that he has vascular prblems and inadequate brain perfusion

if the patient didn`t cancel his appointment , and recieved the suitable trearment for TIA , he wouldn`t develpe the infarction that worsened his case

Al Durra's picture
Al Durra
بعد التخرج

i want only to add some info about this case that the sensation of curtain passing across the visual field can be characteristic of either amaurosis fugus or retinal detachment... and in this case the cause is amaurosis fugus... which is due to cholesterol plaque realese and is a precursor of retinal artery occlusion...

SALAM

marabd's picture
marabd


thanx guys

DAM's picture
DAM
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