Island Med Student

Today was a good day in neuro. Our patient presented with signs of a CVA (cerebrovascular accident), and we were able to deduce that the likely culprit was an ischemic infarct of the MCA (middle cerebral artery).

Also, I learned some stuff:

1) The differential diagnosis of ptosis.
a) muscular (myasthenia gravis, muscular dystrophy, progressive external opthalmoplegia)
b) third nerve palsy (tumor, or vasovasorum (diabetes mellitus)
c) metabolic
d) traumatic (cataract surgery)

2) If you see unilateral ptosis w/ normal pupil size, it’s likely due to diabetes mellitus. If you see unilateral ptosis w/ a dilated pupil, it’s a third nerve palsy

3) The most common cause of bilateral third nerve palsy is a CVA (number one type of CVA is of PCA (posterior communicating artery).

4) If you need to do carotid surgery on an elderly patient, or one with multiple comorbidities, it’s better to place a stent, rather than doing an endarterectomy.

5) If you have a pontine CVA, the gaze preference will be to the SAME side as the weakness.

6) If you have an MCA CVA, the gaze preference will be to the OPPOSITE side of the weakness (as we saw with our patient).

7) If you have increased intracranial pressure, your body will compensate by becoming hypertensive and bradycardic. You may also see hyperventilation (this can be utilized as a treatment as well).

More fun to come!

Note: Since my last photos were so popular, I took some more to go along with this post. The book is Bates’ Guide to Physical Examination and History Taking, from the chapter on neurological examinations.