|
|
Post by pbruss on May 31, 2014 2:06:22 GMT -5
35 year old female come in with suddenonset of posterior headache and vertigo. also reports "palpitations" for past 7 days. reports nausea but denies any cp, sob, abd pain, wekaness or numbness. vital signs are all normal. physical exam is normal with the exception of ataxia and positive rhomberg. CT of her brain in normal. attached is her EKG. which of the following would the mext best test in treatment? A. MRI of brain B. TEE C. CTA heand and neck D. Serum magnesium level E. Lyme titer Attachments:
|
|
|
|
Post by pbruss on May 31, 2014 21:27:33 GMT -5
i forgot to mention that hte headache (which brought her in) started suddenly 1 hour prior to arival
|
|
|
|
Post by Bjs04f on Jun 2, 2014 8:08:14 GMT -5
EKG looks like runs of svt. Check a mag level quickly. Hypomag can cause svt and reversibr cerebellar symptoms. However safest feels like CTA head and neck. Sudden headache with neuro changes. Worst thing I can think of is SAH.
|
|
|
|
Post by Bjs04f on Jun 2, 2014 8:16:52 GMT -5
Supposedly acute severe hypomag mimic pres with sudden onset reversible neuro signs.
|
|
|
|
Post by kemple on Jun 3, 2014 16:20:21 GMT -5
I'm thinking she's going in and out of junctional rhythm, which to me means no atrial kick = clots. Debating TEE vs CTA but in this case with vertigo and headache I would go CTA for posterior circulation issues.
|
|
|
|
Post by pbruss on Jun 4, 2014 2:29:31 GMT -5
C is waht i was looking for.MRI and TEEw ould be usefull but with her presenting wintin an hour of onset there is potential to reverse her symptoms. You guys picked it up on the EKG. Both the cardiologist and I do not know how to officailly qualify this rythm. it is narrow but there is intermittent lack of atrial activity. With the sudden onet of neuro deficits the CTA was done which showed a clot in the right verterbral artery. she got TPA, and was discharged on coumadin and to see an electrophysiologist at Cleveland Clinic for further testing. her neuro exam is doccumented as normal on the discharge summary. i attached the EKG that hopefully shows hte lack of p waves. Attachments:
|
|
|
|
Post by slevittMD on Jun 4, 2014 16:30:47 GMT -5
EM:RAP this month talks about the fact that you can have a positive Rhomberg test with peripheral vertigo. Obviously, the ataxia is concerning though, which along with new onset posterior headache would be enough reason for me to investigate further.
|
|
|
|
Post by mcclain on Jun 7, 2014 15:52:44 GMT -5
Interesting case!
|
|
