dimps
Forum Guru
Topics: 63
Posts: 446
|
Q A 62 yr old woman with a history of depression & HT presents complaining of recurrent falls over the past 6 months .She had been having difficulty with complex tasks at work & was recently asked to leave . On examination her mental status is unremarkable. Her cranial nerve examination is notable for limited downward gaze .She has prominent symmetric bradykinesia with more axial then limb rigidity .There is no resting tremor .Her gait is stiff with "en bloc" turning. Reflexes r normal ,with downgoing toes ,An MRI of the brain is read as showing a small lacunar infarct in the left putamen .she has recently been started on L-Dopa /carbidopa but has had little to no improvement in her symptoms.Which of the following is the most likely diagnosis
a..basal ganglia stroke
b..CO poisoning
c..cervical stenosis
d..parkinson disease
e..progressive supranuclear palsy
___________________
hi how r u
|
| dr.shar
Forum Elite
Topics: 38
Posts: 236
|
e..progressive supranuclear palsy
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
a....?
|
| tasneembanu
Forum Guru
Topics: 96
Posts: 545
|
is it A?
|
| usmleasr
Forum Guru
Topics: 105
Posts: 970
|
ans E. progressive supranuclear palsy...
DD for parkinsonism....but vertical gaze palsy gives the clue..
|
| dnaprimase
Forum Junior
Topics: 2
Posts: 47
|
my friends the answer is definitely a let`s look at the impt pnt s
a positive hx of hypertension and the mri shows a lacunar infarct in the putamen.
baslacunar infarcts can present as
;
weakness or paralysis of the face,
sudden numbness
diff speaking
clumsiness of hand or arm
weakness or paralysis of eye muscles
other neurological symptoms
the Initial complaints in PSP are typically vague and an early diagnosis is always difficult. The primary complaints fall into these categories: 1) symptoms of dysequilibrium, such as unsteady walking or abrupt and unexplained falls without loss of consciousness; 2) visual complaints, including blurred vision, difficulties in looking up or down, double vision, light sensitivity, burning eyes, or other eye trouble; 3) slurred speech; and 4) various mental complaints such as slowness of thought, impaired memory, personality changes, and changes in mood.
mri findings In progressive supranuclear palsy:, definite atrophy of the midbrain and of the region around the third ventricle is seen in slightly more than half of the cases. Minimal signal abnormalities are sometimes seen in the periaqueductal region, but MRI studies remain of little help in establishing the diagnosis
|
| dnaprimase
Forum Junior
Topics: 2
Posts: 47
|
my friends the answer is definitely (a) let`s look at the impt pnt s
a positive hx of hypertension and the mri shows a lacunar infarct in the putamen.
baslacunar infarcts can present as
;
weakness or paralysis of the face,
sudden numbness
diff speaking
clumsiness of hand or arm
weakness or paralysis of eye muscles
other neurological symptoms
the Initial complaints in PSP are typically vague and an early diagnosis is always difficult. The primary complaints fall into these categories: 1) symptoms of dysequilibrium, such as unsteady walking or abrupt and unexplained falls without loss of consciousness; 2) visual complaints, including blurred vision, difficulties in looking up or down, double vision, light sensitivity, burning eyes, or other eye trouble; 3) slurred speech; and 4) various mental complaints such as slowness of thought, impaired memory, personality changes, and changes in mood.
mri findings In progressive supranuclear palsy:, definite atrophy of the midbrain and of the region around the third ventricle is seen in slightly more than half of the cases. Minimal signal abnormalities are sometimes seen in the periaqueductal region, but MRI studies remain of little help in establishing the diagnosis
|
| son64
Forum Elite
Topics: 34
Posts: 245
|
This is one of the parkinsons plus sydromes which are characterized by relative unresponsiveness to cardidopa.There are three such sydromes
1-supranuclear palsy
2-olivopontocerebellar palsy and
3-shy dragger syndrom
This woman has supranuclear palsy.
|
| dnaprimase
Forum Junior
Topics: 2
Posts: 47
|
dimps whats d answer
|
| tuesday
Forum Senior
Topics: 7
Posts: 207
|
A... bec. of htn hx. & MRI findings
|
| dimps
Forum Guru
Topics: 63
Posts: 446
|
answer is E ,,
Q book Q pg 74
___________________
hi how r u
|
| dimps
Forum Guru
Topics: 63
Posts: 446
|
answer is E ,,
Q book Q pg 74
___________________
hi how r u
|
| tuesday
Forum Senior
Topics: 7
Posts: 207
|
will change my answer to E supranuclear palsy. Just encountered this in Q book recently.
|
|
| |
| | | | | | | | | | | | | |
