Acute Care: Focal Neurologic Deficit

BRAIN LATERALIZATION

Differential Dx

Imaging? CT or MRI

How will the test help you to:

CT: Acute Setting, Hemorrhage

MRI: Characterize an abnormality initially seen or occult on CT; problem solving

Head CT Search Patterns

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Find the following:

Search Patterns: Outside In

General Pre-Work  

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70 year old male who was brought in by EMS who presents with acute right upper and lower extremity weakness and a headache.  The symptoms began 2 hours prior to presentation.


Differential Diagnosis?Localize the lesion?Treatment Decisions?

61 year old, found down, last known well 30 hours prior to presentation. Altered mental status with word finding difficulty.  


Localize the lesion?


40 year old male with HTN and diabetes presents to an outside hospital with acute left upper>lower extremity weakness and neglect.  Symptoms began 1.5 hours prior to presentation

Localize the lesion?


Patient presents with acute right sided weakness - no aphasia, intact sensory

Localize the lesion?


45 year old with acute onset of symptoms while taking out groceries from her car.  Symptoms included numbness involving the right side of her body, weakness of her right upper extremity.  Her husband noticed that her speech also did not make any sense.  The words were spoken clearly, but the content did not make any sense.  She presents to the ER and her symptoms have improved.  By the time you exam the patient, she has a normal neuro exam.  

What should we do? Is there a role for imaging?



65 year old with pancreatic cancer, acute onset left sided weakness, neglect, right sided gaze deviation.  Last known well, 1 hour prior to presentation

Localize the lesion?


52 year old with acute onset of headaches x 2 days with gradual worsening, now with left sided numbness and mild weakness 

Localize the lesion?

59 year old with acute onset of right sided weakness and sensory deficits, eye deviation to the right.

Localize the lesion?