NEURO



LOSS
OF
CONSCIOUSNESS


HPI:
65
YO
FEMALE
C/O
LOSS
OF
CONSCIOUSNESS
YESTERDAY
WHILE
CARRYING
GROCERIES.
PATIENT

REPORTS
THAT
IMMEDIATELY
PRIOR
TO
LOC
SHE
FELT
DIZZINESS
AND
DIAPHORESIS,
PATIENT
REPORTS

THAT
THE
NEIGHBOR
OBSERVED
SHAKING
OF
THE
ARMS
AND
LEGS
WHILE
PASSED
OUT,
UPON

RECOVERY
PATIENT
WAS
CONFUSED,
DIZZY,
AND
LIGHTHEADED
AND
NECK
PAIN.
THE
NECK
PAIN
IS
9/10

INTENSITY,
SHARP
AND
POUNDING,
NONRADIATING,
IS
CONSTANT
SINCE
THE
FALL
AND
PROGRESSIVE.

NO
ALLEVIATING
FACTORS,
AGGRAVATED
BY
MOVEMENT.
THESE
SYMPTOMS
LASTED
FOR
A
FULL
DAY

AND
ARE
CONTINUOUS
UP
UNTIL
NOW.
PATIENT
DENIES,
TONGUE
BITING,
URINARY
OR
BOWEL

INCONTINENCE,
OR
TRAUMA
DURING
G
FALL.
PATIENT
DENIES,
FEVER,
CHEST
PAIN,
BOWEL
OR

BLADDER
CHANGES,
SPEECH
CHANGES,
NO
NUMBNESS
OR
WEAKNESS.



OBGYN:
LMP
10
YEARS
AGO
NO
CHILDREN
2
MISCARRIAGES
IN
HER
30’S

ROS:
BOWEL
RESECTION
8
YEARS
GO,
PACEMAKER
IMPLANTATION
2
YEARS
AGO,
COSMETIC
SURGERY

FOR
FACE
AND
ABDOMEN
1
YEAR
AGO

PMH:
DIAGNOSED
WITH
HTN
10
YEARS
AGO,
MI
5
YEARS
AGO,
HOSPITALIZED
FOR
TWO
WEEKS
FOR

COSMETIC
PROCEDURES,
HOSPITALIZED
FOR
2
DAYS
FOR
BOWEL
RESECTION,
HOSPITALIZED
FOR
3
DAYS

FOR
MI.

PSH:
FACE
LIFT
AND
ABDOMINAL
LIPOSUCTION
1
YEAR
AGO,
PACEMAKER
IMPLANTATION
5
YEARS
AGO,

BOWEL
RESECTION
8
YEARS
AGO.

FH:
PATIENT
IS
ONLY
ONE
IN
HER
FAMILY
OF
PARENTS
AND
SIBLINGS
ALIVE
TODAY

SH:
DENIES
TOBACCO,
DRINK
2
BOTTLES
OF
WINE
A
DAY,
CAGE
4/4,
USES
MARIJUANA
WEEKLY
FOR

ANXIETY,
LIVES
WITH
DAUGHTER
AND
TWO
GRANDCHILDREN
IS
A
RETIRED
ATTORNEY.



PHYSICAL
EXAM

GA:
PATIENT
IS
IN
ACUTE
DISTRESS
WITH
SIGNIFICANT
DIAPHORESIS
AND
EXTREMELY
ANXIOUS.


VS
INDICATE
PATIENT
IS
IN
HYPERTENSIVE
CRISIS
WITH
INCREASED
HEART
RATE,

VS:
BP
165/78

HR
99

HEENT:
BRUISING
ON
LEFT
HEMISPHERE,
TENDER
TEMPORAL
REGION.
NORMCEPHALIC,
PERRL,
NO

ICTERUS,
NO
CYANOSIS,
NO
PALLOR,
NO
CONJUNCTIVAE

MOUTH
AND
PHARYNX
CLEAR

NECK:
+LAD,
NUCHAL
RIGIDITY
PRESENT
DECREASED
ROM
ON
FLEXION
AND
EXTENSION,
DECREASED

ROM
ON
LEFT
TO
RIGHT
ROTATION.
THYROID
WNL.

HEART:
RRR
S
1
S2
NORMAL,
HR
99
BP
165/78

CHEST:
CTAB

NEURO:
MME:
ALERT
AND
ORIENTED
TIMES
2
PATIENT
CANNOT
REMEMBER
HER
NAME,
CN
2‐12

INTACT,
MOTOR
STRENGTH
5/5
THROUGHOUT,
DTR’S
INTACT,
SENSATION
IN
TACT
TO
DULL
AND

SHARP,
ROMBERG
+,
GAIT
ATAXIC,
SPEECH
SLURRED.



DD:

SEIZURE
TONIC
CLONIC

SUBDURAL
HEMATOMA

INTRACRANIAL
BLEED

AORTIC
STENOSIS

CARDIAC
ARRHYTHMIA

STROKE

TRANSIENT
ISCHEMIC
ATTACK

ACUTE
ISCHEMIC
ATTACK

ALCOHOL
INDUCED
SYNCOPE



WORK
UP:

CBC
WITH
DIFFERENTIAL/UA

LP
CSF
FLUID

ETOH
LEVELS

MRI
BRAIN

CT
HEAD

PT/PTT
INR