Another real case

[crazycajun]

33 yo Female non smoker or drinker and no drug use. Worked as dispatch for SO. Med Hx shows only complaint of numbness to lower extremities on occasion. 4 MRI's in 3 months on spine inconclusive. PT at work taking call and froze. Supervisor noticed and had another dispatcher take over call. PT was asked if anything were wrong and she stated that she just couldn't do it anymore. Told supervisor she had forgotten how to do her job. Got up and left. Drove 1.1 miles to home and upon arrival could barely walk. All previous med Hx showed cause of numbness to be stress related or possible nerve damage. Let me know if you need any more info.

 

[mycrofft]

What's the question?

Take two weeks off, get help through employee assistance program, tell admin to quit making folks work long hours, and see if it gets better, especially after quitting. See private MD, file for stress disability, and follow up PRN.

 

[crazycajun]

The question is can you figure out her actual diagnosis? The previous diagnosis in med Hx was wrong. I will add that after correct diagnosis, it was learned PT had been writing reminder notes.

 

[mycrofft]

OOps premature posticulation.

See below:blush:

 

[mycrofft]

Well, losing your short term memory and gaining paroxysmal weakness will stress you.

Could be a tumor, electrolyte imbalance, incipient MS or something similar and supratentorial. Some sort of abscess leaking a neuro-exotoxin? Has she an arrythmia? Cystercercosis? Seizures of any sort?

Leaking breast implant.....No, not that again.h34r:

 

[IAems]

Neurological problems are always the most interesting

This could be environmental (some sort of Teratogenic Agent) or genetic (some sort of Leukoencephalopathy resulting from Amyloidosis). Did the head to toe assessment show any rashes, edema, or insect bite marks? Is there an apparent trigger for the paresthesia reported by the patient?

 

[crazycajun]

Sorry I am just getting back to you. Final correct diagnosis was 9cm tumor affecting Cerebral and Parietal Lobes of the left side. PT never had any other symptoms. Surgery found to be cancerous and now PT is paralyzed right side, loss of speech after removal of tumor. Possible stroke during surgery?

 

[mycrofft]

9 cm tumor? Lucky she didn't lose the reflex to breathe much less speak.

Sorry to hear about it.