bioguy
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i will need great help in this case. i haven't touched neuroanat yet.
weakness of one arm and leg started an hour ago - and the symptoms are gradually increasing.
does this mean a progressive clot (less likely) or an increasing hemorrhage?
sorry, i am not asking if its one or the other. i am asking if this is what it could be, or are there other reasons behind a progressively increasing symptom
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| bioguy
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What pathophysiological significance does migraine headaches have in this case?
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| bioguy
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Ask about Family history of brain aneurysms.
what familial syndromes are associated with brain aneurysms?
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| bioguy
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how you felt most of the days before the weakness ?
how is your home situation ?
can someone please explain the purpose of these questions
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| kleovoulos
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hi bioguy!
ok, let me try some of your qs..as far as I remember...
''how is your home situation ? '' :
it could probably have to do with the fact that an abrupt stress-induced BP elevation(e.g after an argument, a worry etc..) could lead to the rupture of an existing aneurysm.
''how you felt most of the days before the weakness ? '' :
try to investigate the existence or not of signs and symptoms which could reveal the background of the presenting features( signs of pressure of structures, increased ICP e.g. headache, blurred vision, nausea- vomiting..., a previous acute onset excruciating headache some days b4( sentinel bleeding of subarachnoid..., signs of a TIA in the past etc.)
Although you do not mention the existence of pain you may probably remember that ischemic strokes do not cause pain, whereas the hemorrhagic ones do. ask about that.
''what familial syndromes are associated with brain aneurysms?'':
As far as I remember, some typical syndromes that include brain aneurysmas are APKD( Polycystic kidney), Marfan, Ehlers-Danlos.
''What pathophysiological significance does migraine headaches have in this case?'':
I'm not sure but I've read that migraine headaches with aura can sometimes present with sensory or motor symptoms( instead of the visual aura which is more common in this type), so you must probably include it in your differential( focal symptoms of migraine occur in a marching time pattern whereas stroke has an acute onset).
Well, I hope this gave u some ideas...
......of course, I do not claim all I say is right..I'm just trying to give some clues for u to search..I haven't studied for CS yet, I am studying for my CK now..but not done with neuro yet.
I wish u good luck!!
To all: come on guys..give some more ideas!!!
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| bioguy
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excellent!! that makes sense.
thanks, buddy!!
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| bioguy
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one of the DDs is Conversion disorder.
whats that?
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| kleovoulos
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Conversion disorder is one of the so-called ''Somatoform Disorders''. The patient presents with a sensory or motor deficit( blindness, paralysis) of sudden onset. The triggering event usually is a stressful life event. Despite the deficit, the patient seems unconcerned about that and this is called ''la belle indifference''!
Conversion disorder is more common among young people and as far as I understand, there's no organic background.
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| arlete
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kleovoulos:
You are so on the top of your game!!!! 
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| bioguy
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oh man!!! i should be reading more often.
don't remember ever reading this kinda thing in those ol'days
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| kleovoulos
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 arlete thank u so much...
I haven't gone that deep into this. I only had read about that in the behav book I used for step1( HY)..that book was so brief and concise...just what I needed
....in addition, conversion disorder was kinda impressive for me...presenting with such deficits and not even feeling upset about that! wow..
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| arlete
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 Interesting.
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| adiagra
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hi
kleovoulos i appreciate the way you thought
thats a sign of an excellent physician in the making
migraine is associated with vosoconstriction / vasospasm of cerebral blood vessels
indicating disorder of cerebral blood vessels.
corect me if i'm wrong.
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| bioguy
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any association between migraine and cerebrovascular events like clotting/rupture??
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| kleovoulos
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adiagra thank u for ur kind words!
I agree with u regarding the pathophysiology of migraine headaches.
I think that the phase of vasoconstriction leads to the symptoms of aura, whereas the phase of vasodilation, which ensues, accounts for the headache( and that's why we use constrictive meds for migraine headaches).
However, I don't know if there is a correlation between migraine and stroke(bioguy), in terms of pathophysiology( if this is what u mean).
As far as I understand, migraine is more of a functional issue of the vessels...but I can't tell anything else for sure..
May sb else give their oppinions!
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| kleovoulos
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''You can be rude to me on the internet, but do that on a street and you'll get a bullet in your head!!!!''
hey bioguy, no need to be violent
(just kidding..no offence dude )
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| arlete
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bioguy:
Yes, there are a few studies showing that people with migraine have a tendency for ischemic stroke and some physicians advise them to take one Aspirin a day. Or so I was told. I'll try and find something on the Internet.
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| arlete
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http://headaches.about.com/od/migrainediseas1/a/m...
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| arlete
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kleovoulos:
He's saying that because he's armed... I wonder if he weren't...
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| kleovoulos
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that's true
...but I'll never be rude to him..u never know..
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