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sprint123
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Topics: 129
Posts: 870

04/17/07 - 06:40 AM

A 76-year-old woman comes to the emergency department after falling in her house. The daughter witnessed the episode and states that her mother fell on her left side but did not pass out or hit her head. Her mother had a hard time getting to her feet and had to be helped up. The patient denies dizziness, palpitations, or loss of consciousness. She also has hypertension, diabetes with gastroparesis, and peripheral vascular disease. She has had occasional urinary incontinence and memory loss. Her medications are aspirin, atenolol, lisinopril, glyburide, metformin, metoclopramide, and cilostazol. The patient is alert but has decreased concentration and a markedly impaired memory. She has normal language function. The cranial nerves are intact, and there is increased tone in the lower extremities bilaterally with 4/5 motor strength in all muscle groups. The deep-tendon reflexes and cerebellar function are normal. She has a broad-based stance, hesitant initiation of walking, and a shuffling, ataxic gait. What is the next step in the management of this patient?

(A) Discontinue metoclopramide
(B) CT scan of the head
(C) Lumbar puncture
(D) Start levodopa/carbidopa (Sinemet)
(E) Donepezil
(F) Ventriculo-peritoneal shunt

doc_clotaire
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Topics: 159
Posts: 1,301

04/17/07 - 08:58 AM

Normal Pressure Hydrocefalus

NSIM -------------B ) CT Scan of the Head

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Justice
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Topics: 118
Posts: 2,369

04/17/07 - 09:04 AM

Yep, Normal Pressure Hydrocefalus that needs to be confirmed by (B) CT scan of the head

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cookie909
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Topics: 0
Posts: 18

04/17/07 - 10:32 AM

What will normal prsr hydroceph look like on CT scan?

dr.wad
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Topics: 3
Posts: 350

04/17/07 - 10:39 AM

A _ this is drug induced parkinsonism.

other toxins cause parkinsonism: co , phenothiazines, methyl dopa

Justice
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04/17/07 - 10:55 AM

dr.wad wrote:
A _ this is drug induced parkinsonism.

other toxins cause parkinsonism: co , phenothiazines, methyl dopa

Progressive mental impairment + gait problems + bladder incontinence ===> Normal Pressure Hydrocefalus

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Justice
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Topics: 118
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04/17/07 - 11:03 AM

cookie909 wrote:
What will normal prsr hydroceph look like on CT scan?

ventriculomegaly
Regresses after shunting => gait improvement

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dr.wad
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Topics: 3
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04/17/07 - 11:17 AM

Justice , u r correct...... nod

thx

cookie909
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Posts: 18

04/18/07 - 07:13 AM

thank u justice

sachida
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Topics: 62
Posts: 625

04/18/07 - 01:37 PM

#10

B
Also adds benifit of evaluating any intracranial bleeding due to fall

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