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Unusual patient -Reply

I'll take a stab and see migraine.

Michael Ryan
Sydney. Australia.

>>> Teppie <> 3/July/1998 12:16pm >>>
	I am taking care of 14yo who presented to my office with the
complaint of
tingling and numbness of her right foot, leg, hand, arm and face.  She
had
been at the pool with a friend swimming whtn she began comlaining of
the
numbness so they decided to go home.  They rode home on bicycles
with no
mishaps or falls.  When she got home, she laid on the couch for a few
minutes, then her mom got her back up and she was somewhat wobbly
with
walking.  At that point, the mom decided to bring her in.
	PMH is significant for a head injury in 1993 which resulted in LOC
for
several hours but no further problems after the concussion resolved.
There
was no bleed or fracture.  There is some significant family history.
	On examination, the patient was alert with diffuse slowed
mentation,
severe confusion, aphasia, apraxia and mild hemiparesis of the right side
from the forehead to the toes.  She had no other physical signs and no
fever.  She completely failed a mini mental status exam, unable to state
even her own name or count.  She could follow only simple instructions
and
could not demonstrate how to use a pen even after she was shown
how, nor
could she read anything.  However, she appeared to be completely alert,
although somewhat agitated when she could not answer questions, and
she
would answer "I don't know" to almost every question we asked.
	What do ya'll think we should include in the differential?  Have you
ever
seen anything like this?  She has been scary to take care of because of
the
difficulty in following her mental status.
	(I have a little more history and the results of a few tests but will
give
them after I get some feedback.)

Thanks for the input.

Dr. Carol
Carol F. Teplis, MD
Associates in Pediatrics
Elgin and Streamwood, Illinois

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