A 64-year-old male with hypertension presents with sudden on…
A 64-year-old male with hypertension presents with sudden onset of right eye blindness while shaving this morning. He describes a “curtain falling over my right eye,” which cleared spontaneously after 10 minutes. He had no other concurrent neurologic symptoms and no prior episodes of similar description. His general examination reveals a blood pressure of 140/90 mmHg, but it is otherwise unremarkable. Neurologic exam is normal. Which of the following conditions is the most likely diagnosis?
Read DetailsA 26-year-old female patient with no significant PMH is brou…
A 26-year-old female patient with no significant PMH is brought to the Emergency Department after experiencing a witnessed generalized tonic-clonic seizure in the supermarket. The seizure ended after 2 minutes, but the patient remained confused. Vital signs: BP 118/72, HR 90/min, RR 16/min, T 98.6F On exam, she is currently alert and fully oriented. She does not remember the events during the seizure and states she has not experienced this before. There is no nuchal rigidity and motor and sensory exam is unremarkable. Fingerstick blood glucose is 100 mg/dL. Serum electrolytes, CBC, and urine toxicology results are all within normal limits. EKG is without abnormality noted. What is the most appropriate next step in the management of this patient?
Read DetailsHyperglycemia before reperfusion in patients with acute isch…
Hyperglycemia before reperfusion in patients with acute ischemic stroke has been associated with diminished neurologic improvement, greater infarct size, and worse clinical outcome at three months after treatment with intravenous tPA.
Read DetailsA 24-year-old woman, who has been consuming a strict total v…
A 24-year-old woman, who has been consuming a strict total vegan diet (without dairy products or eggs) for the past 6 years, presents with a 2-week history of persistent fatigue and decreased functional capacity. She also gives history of numbness and pins and needle sensation in her feet for the past 3 weeks. The patient is having other problems, such as increased irritability and forgetfulness. Physical exam reveals pallor, peripheral neuropathy of her lower extremity, and memory deficits. CBC shows a macrocytic, normochromic anemia. There is also an elevation in the levels of methylmalonic acid and homocysteine. Which of the following therapies is indicated for this patient?
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