Case Study

[CaseManager1947]

I have a Case Study for you:

45 y/o female is admitted to a Psychiatry unit with a hx of Bipolar Affective Disorder. She has been treated for this successfully and been in remission for a number of years. Her chief complaint is "my legs and arms don't work right". Family reports loss of sleep and the patient has been falling, and has fallen at least 20 times in the past 2 weeks, prior to admission. There are no abnormal lab values. She has contralateral paralysis and vertical nystagmus. She is also having a slight cough. Social hx is negative for alcohol and positive for tobaccoism, with a 35 pack yr hx of smoking. The team and some of the nurses believe she is feigning her sx. What do you think her diagnosis really is???

[CaseManager1947]

This case, as I said, stumped TWO neurologists before she was finally diagnosed. She had CT scans from top to bottom, all labs neg. as I said. Finally, diagnosed with Paraneoplastic syndrome due to small cell ca in the lung (teeny-tiny). finally showed up on a CT done at Mayo Clinic. Many cancerous tumors are hormone producers, and this one was, producing the odd sx described in the case study here. This was such an interesting and different case, I thought I would share it with you all... Hints: 1.) smoker 2) cough

[RedhairedNurse, BSN, RN]

If she is on any of those psych meds (resperdal) that can cause extrapyrimidal side effects such as dystonia, etc. This could be her problem as well.