IM 2-41 Repeated Falls

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IM 2-41 Repeated Falls

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DrVirgo
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06/12/07 - 09:27 AM

An 82 year old woman comes in to the doctor's office with her daughter because of repeated falls without apparent cause. The patient reports that she fell to the ground because of a sudden loss of strength in her legs without losing consciousness or feeling dizzy. She lay on the floor for a few minutes until she recovered strength and became able to stand up adn walk again. She is otherwise in good health and takes alendronate for osteopofosis. Exam reveals mild resting tremor of her hands, but there is no rigidity or slowing of movements. Vital signs are stable. On auscultation, a bruit is heard over the right carotid artery. Which of the following is the most likely cause of the patient's falls?

A. Adverse drug reaction
B. Lateral medullary infarction
C. Parkinson disease
D. Postural hypotension
E. Transient ischemia in the carotid territory
F. Transient vertebrobasillar ischemia

Please explain why you pick your answer.

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khorshid
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06/12/07 - 09:39 AM

E
My reasons: 1.It's not an infarction because she regained the strength 2. Not parkinson, because of lack of other signs and symptoms, 3. not hypotension because of lack of dizziness or faint or ...
and because it is like a TIA, and she has bruit over her carotid.
correct me if I am wrong.

Justice
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06/12/07 - 11:00 AM

F. Transient vertebrobasillar ischemia
To choose E, I would like to see visual disturbances and altered consciousness

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prathapdoctor
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06/12/07 - 11:53 AM

But in vertebrobasilar ischemia you genreally see cranial N symptoms rather than only leg weakness.

I would go for E only. Do you surely see altered conciousness in a simple TIA, I dont think so.

ssrpk
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06/12/07 - 01:19 PM

i will go with E as well

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cirus
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06/12/07 - 01:29 PM

The ans is E

krsna
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06/12/07 - 09:01 PM

the fall episodes are pretty characteristic of vertebro basilar ischemia...ans F

DrVirgo
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06/13/07 - 10:20 AM

I was stuck between E and F also.

Answer is F

These "drop attacks" are caused by transient ischemia of the vertebrobasilar artery.

If the person presents with sensory, motor deficits, as well as alterations in language, expression or comprehension, then the answer would be stenosis of the carotid artery.

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khorshid
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06/13/07 - 05:54 PM

Thanx that was a good one.

maninder_amc
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06/14/07 - 05:54 PM

#10

so does this presentaion have anything to do with the carotid bruit....??????????

or does it imply that there is generalised athersclerosis and the subclavian arteries might have been involved also( but it is not a common site for atherosclerosis)

since vertebral arteries arise from the subclavian arteries, and the vertebral arteries on both sides join to form the vertebrobasilar artery,...........

anybody please answer....

maninder_amc
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06/14/07 - 05:55 PM

#11

vertebrobasilar insufficiency cant be caused by caotid stenosis.....

maninder_amc
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06/14/07 - 05:56 PM

#12

hey virgo whats the explanation.....

Justice
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06/15/07 - 08:23 AM

#13

maninder_amc wrote:
so does this presentaion have anything to do with the carotid bruit....??????????

or does it imply that there is generalised athersclerosis and the subclavian arteries might have been involved also( but it is not a common site for atherosclerosis)

since vertebral arteries arise from the subclavian arteries, and the vertebral arteries on both sides join to form the vertebrobasilar artery,...........

anybody please answer....

The carotid bruit is a distractor for your attention, my friend...

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