Login to your account
Don’t have an account?
Create a Free AccountInternal Medicine Flashcard Archive
A middle-aged woman with numbness and weakness of the extremities
A 45-year-old woman presented to the neurology department with numbness and weakness of extremities, which had progressed during 3 months. The patient had tingling sensation in the left neck. Although muscle atrophy was not observed, manual muscle test revealed grade 4 weakness in bilateral deltoid muscles, right upper and left lower limbs. The patient had normal deep tendon reflex, and Babinski reflex was negative bilaterally. Laboratory blood tests showed no abnormalities. Spinal fluid examination revealed a slightly increased protein level of 56 mg/dL (normal range: 10–45 mg/dL) and no white blood cells.Disturbance of consciousness after postpartum hemorrhage
A 37-year-old woman with postpartum hemorrhage was transferred by ambulance to our hospital for emergency treatment. On arrival massive hemorrhage continued, and she developed tachycardia (130 beats/min), hypotension (60/30 mm Hg) and tachypnea (50 /min). She underwent blood transfusion and emergent hysterectomy, and her vital signs became stable. The estimated total bleeding volume was approximately 8 L, and pathological examination revealed placenta accreta. Five days later, she had disturbance of consciousness.Sudden onset headache, dizziness, unilateral facial numbness, and speech disturbance
A 48-year-old woman presented to the emergency department with acute onset of headache, dizziness, right facial numbness, and difficulty of swallowing and speech. She was not a smoker and consumed alcohol occasionally, and there was no surgical or other medical history. On admission, her blood pressure was 114/78 mm Hg, pulse rate was 72 beats per minute, and room air arterial oxygen saturation by pulse oximetry was 100%. Laboratory tests showed no abnormalities. Physical examination revealed paresthesia of right side of face and left lower extremity and paralysis of right vocal cord, but with no other neurological findings such as consciousness disturbance, cerebellar ataxia, double vision, and hemiparesis.A middle-aged woman with severe disorders of consciousness
A 47-year-old woman presented to the emergency department of the author's hospital with severe disorder of consciousness. She had been epileptic since early childhood and had many epileptic family members. Thus, she had been receiving anticonvulsants such as carbamazepine (CBZ) and diazepam. Her Glasgow coma scale on admission was 5 (E1V1M3). Brain computed tomography revealed no abnormalities, and electroencephalography revealed no seizure activity. An electrocardiogram showed normal sinus rhythm.Dyspnea of a woman living in an old wooden house
A 38-year-old woman presented to the emergency department with aggravated dyspnea at rest and productive cough for one week from late July. She was born and married in Brazil. Then she immigrated to Japan, and she had lived in an old wooden house with her husband, one son and a dog for six years. She had no smoking history and no history of significant respiratory disease. Fine crackles were detected on auscultation of her lungs. Room air arterial oxygen saturation by pulse oximetry was 98%. Laboratory tests showed an increased white blood cell count of 13,600/μL, an elevated C-reactive protein level of 5.1 mg/dL (reference value, < 0.2 mg/dL) and an elevated Krebs von den Lungen-6 level of 2207 U/mL (reference value, <500 U/mL).A schizophrenic man with severe disorders of consciousness
A 48-year-old man with severe disorders of consciousness and fever up to 38 °C was transferred from a psychiatric hospital to the author's hospital. He had suffered from schizophrenia for 15 years and experienced body weight loss of 6 kg in last 20 days. He was in coma with the Glasgow coma scale (GCS) 3. Blood tests showed decreased levels of serum glucose (26 mg/dL; reference value, 70–110) and serum albumin (2.6 g/dL; reference value, 6.3–8.0), and elevated white blood cell counts (23,800/μL), C-reactive protein (1.49 mg/dL; reference value, < 0.2), AST (3175 U/L; reference value, 13–33), ALT (3681 U/L; reference value, 8–42) and CK (1945 U/L; reference value, 62–287).
The content on this site is intended for healthcare professionals.
Copyright © 2023 Elsevier Inc. except certain content provided by third parties.
