Morning Report: Left sided weakness and difficulty speaking
Mar 26, 2020
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Three resident physicians, Dr. Lindsay McAlpine, Dr. Chris Traner, and Dr. John Picard, analyze a case of a 55-year-old woman with left-sided weakness and speech difficulties. They explore the importance of conducting a full neurological exam, differentiating between ischemic and hemorrhagic strokes, and discussing treatment options for stroke localization. The podcast emphasizes the significance of anatomy review, stroke syndromes, and management strategies in clinical cases.
Identification of vascular etiologies crucial in sudden-onset neurological symptoms.
Treatment with aspirin and statin therapy for pontine stroke from small vessel disease.
Deep dives
Case Presentation and Initial Assessment
A 55-year-old woman presents with 10 hours of left-sided weakness and difficulty speaking, alongside a history of poorly controlled hypertension. The case prompts a detailed review of anatomy and localization, with emphasis on vascular conditions given the patient's sudden onset of neurological symptoms. The discussion leans towards potential vascular etiologies, particularly acute ischemic or hemorrhagic stroke, based on the symptom presentation.
Physical Examination Findings and Differential Diagnosis
The physical examination reveals left-sided weakness, dysarthria, mild left facial droop, and impaired sensation in the left arm and leg. These findings suggest a small vessel territory involvement or a brainstem condition. Differential considerations focus on internal capsule or brainstem pathologies, pointing towards a vascular origin due to the absence of cortical signs.
Treatment and Follow-up
Following investigations including CT imaging and a clinical exam, treatment involves aspirin and statin therapy due to a pontine stroke from hypertensive small vessel disease. The patient shows improvement over several days, with residual mild deficits. The anatomy is discussed in relation to sensory and motor dysfunction, highlighting pontine lesions and the potential involvement of thalamic pathways.