Poisoned a 44 year-old truck driver
Case 6
A 44 year-old truck driver is brought to the emergency department by ambulance. According to his friends, he was getting up from the table after lunch then suddenly groaned, stiffened, and collapsed, with jerking movements of the arms and legs. By the time paramedics arrived, the movements had ceased and he was mumbling incoherently. At first he was confused and moving purposefully; en route to the hospital, his consciousness gradually cleared. By the time you examine him in the ED (about 45 minutes after the event), he is awake and alert, complaining only of a mild headache, and has little recall of what has just occurred.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses for one medication you might prescribe, along with an estimate of the cost of a month of your proposed therapy. How would you counsel the patient about his condition and about any proposed therapy? Poisoned a 44 year-old truck driver.
Case 6
A 44 year-old truck driver is brought to the emergency department by ambulance. According to his friends, he was getting up from the table after lunch then suddenly groaned, stiffened, and collapsed, with jerking movements of the arms and legs. By the time paramedics arrived, the movements had ceased and he was mumbling incoherently. At first he was confused and moving purposefully; en route to the hospital, his consciousness gradually cleared. By the time you examine him in the ED (about 45 minutes after the event), he is awake and alert, complaining only of a mild headache, and has little recall of what has just occurred.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses for one medication you might prescribe, along with an estimate of the cost of a month of your proposed therapy. How would you counsel the patient about his condition and about any proposed therapy?Poisoned a 44 year-old truck driver.