IM dose # 1
I can't feel my face when I'm with you
Hello All,
Sorry for having gone AWOL, work has been quite hectic and I have been super busy. Trying to pick up the newsletter and thinking of doing these cases every week or 2.
I will put out an interesting case like this one below, wait for everyone’s responses and put out an explanation of what the answer is. Keep in mind, these will be similar to cases I have seen during my day-to-day work (Obviously I will change patient details to maintain confidentiality). So some weeks I will have clear answers for the cases, and some weeks I will have very vague answers on how the case was handled because we probably didn’t know what was going on with this patient.
TRUST ME, If you are a soon-to-be F2 or F1 - you WANT to participate in these. They will help you understand how stuff actually works in reality and it will give you an insight into how to manage certain cases and help you build a pool of differentials for different presentations.
Case:
55 year old Asian (Indian) male walks into A&E complaining of slight numbness on the right side of his face that started yesterday evening along with on-and-off twitching. He mentions also feeling pins and needles on the same side and that he woke up this morning drooling on his bed from that side which is NOT normal for him.
No chest pain, No cough, No other neurological sx, no LUTs, no constipation, no fevers.
As you are speaking to him, you do not see any drooping on the face, you do not see any asymmetry.
Past medical history:
Diabetes, Previous IHD, High cholesterol, recurrent leg ulcers due to poorly controlled diabetes
Medication:
Metformin 500mg OD, Aspirin 75mg OD, Atorvastatin 40mg OD, GTN spray 400mcg PRN
Smokes 10-15 a day and has been smoking for 30 years.
Drinks 20 units every week.
QUESTIONS: (Answer in the comments)
What are your top differentials? how would you approach the treatment for each?
What is the most important thing to rule out?
What bloods do you want to order? and what are you looking for in specific?
Any scans you want to order?
What examinations do you want to perform?