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Controversial Q

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Ivonne
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01/09/08 - 09:42 PM

A 44 yo M c/o acute onset of dysarthria, horner's syndrome affecting the right side, hiccoughs, right ataxia, sensory loss to pinprick over the right side of the face and the left side of the body, and intact cognition. The initial unenhanced CT scan of the brain is normal. Which of the following is the best means of acute medical management in this patient?

a. Heparinization and observation

b. Right carotid endarterectomy

c. Left carotid endarterectomy

d. Outpatient follow up

e. Surgical decompression of the cerebellum

Explain your answer pz

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tamerbashir
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01/10/08 - 12:04 AM

motorola
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01/10/08 - 12:32 AM

looks like low brainstem + high spinal cord involvemrnt to me. but the options are quite wierd. i would love to know the answer ! but if u dont get an answer dont worry. real questions are not as ambiguus. or so i think.

dr.wad
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01/10/08 - 03:19 AM

i guess this is occlusion of one of posterior cerebral artery branches .

so treatment is heparin ( A ).

hope this right.

dr.wad
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01/10/08 - 03:40 AM

sorry ..,i was wrong ...this is occlussion of one of the branches of the basilar artery ( the

posterior inferior cerebellar artery ( lateral medullary syndrome of wllengerg ).

neurom
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01/10/08 - 04:15 AM

I think the answer options are incomplete. Angio should be done. It might be PICA occlusion..
I go with A

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Ivonne
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01/10/08 - 07:14 AM

"For every stroke prevented, one intracranial hemorrhage is caused"

What do you say?

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neurom
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01/10/08 - 07:48 AM

Ivonne wrote:
"For every stroke prevented, one intracranial hemorrhage is caused"

What do you say?

A problem- solving approach. We have stroke we gotta do something.
But I don't think that heparin is that great in this condition. Surgical intervention is an option.

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dr.wad
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01/10/08 - 08:07 AM

Ivonne wrote:
"For every stroke prevented, one intracranial hemorrhage is caused"

What do you say?

yes , heparin is used only for stroke in evolution...

so , the ans is outpatient follow up.

Ivonne
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01/23/08 - 01:18 PM

#10

Sorry guys i forgot about this Q
the given answer is A

This patient has had an acute, stable stroke. There is no medical contraindication and no CT evidence of bleeding. Although some physicians might argue that the use of heparin would be of little benefit in this case, there is a small risk associate with its use, and it may treat a coagulopathy unrecognized in the acute stages.

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