cerebrovasculardisease.doc

Cerebrovascular disease A 68-year-old woman with a one-month history of nondescript aching and stiffness in her shoulders and intermittent fever, both responsive to Extra Strength Anacin, comes to your office concerned that she has developed a severe, right frontal throbbing headache and while reading this morning’s newspaper became aware that something was wrong with the vision in her right eye. On examination, she is blind in her right eye. The most likely diagnosis is: How would you confirm your diagnosis? ______________________________________________________________________ A 65-year-old previously healthy housekeeper awakens from sleep unable to stand or walk. On exam, she has moderate-to-severe left leg and foot weakness, mild left arm weakness, is unable to identify numbers drawn over the dorsum of her left foot, but can identify them when drawn over the dorsum of her right foot or palm of either hand. There is no language deficit or visual field loss. The left plantar response is extensor. What is your diagnosis? Where is the lesion? ______________________________________________________________________ A 65–year-old man drove himself to the emergency room after experiencing a sudden-onset ten-minute episode of right hand weakness and word-finding difficulty. He had experienced similar episodes over the last month but this one had lasted considerably longer. In the ER he tells you he has had a long history of hypertension and diabetes for which he takes medications regularly; he takes no other medications. He had a cardiac stent implanted a year ago following an evaluation for unstable angina. His neurological examination is normal except for a mid-calf stocking neuropathy with diminished deep tendon reflexes at the ankles. Where would you localize the brain lesion that caused this man’s symptoms? What vascular territory? What are the risk factors for stroke? What studies would you suggest are appropriate in evaluating this individual’s