Case Study

  1. 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???
  2. 13 Comments

  3. by   trixie333
    Tegratol toxicity has similar sx.....check her meds. for adverse reactions...
  4. by   April, RN
    I'd would wonder about medication toxicity or adverse reaction as well.
  5. by   MikeyBSN
    It could be an organic disorder, and nothing good. She could probably use a CT or MRI. She could could have some sort of weird Basilar artery stenosis/stroke or some other intercranial issue. Does she have Pica? She could have some kind of heavy metal poisoning.
  6. by   morte
    combo of meds and hormone changes, is a possibility
    why are staff nurses of the opinion that she is faking?
  7. by   CaseManager1947
    All of these are good possibilities... none is correct however. MikeyBSN is going down the right path... remember, I said all her labs were normal.. so drug tox is not in the mix. Look again at her social hx for a clue. The contralateral paralysis is bilateral. Rt arm not working, lt leg not working. Left arm working, rt leg working. This is a case that stumped everyone, except a very sharp Neurologist. Try again.
  8. by   MikeyBSN
    Mass in the brainstem?
  9. by   northshore08
    I've never seen a patient fake nystagmus. Is it something to do with heavy nicotine?
    Last edit by northshore08 on Apr 16, '09 : Reason: re-read first post
  10. by   getoverit
    ganglionic blockade in the cerebellum?
  11. by   morte
    didnt read all the way thru, but figured this might apply, the nicotine issue didnt come up on first page of "hits", but may be mentioned in here, as i said, didnt read all the way thru.
    but i am REALLY curious why some nurses thought she was faking????
    i do remember, when i worked as a clerk in an ED, they had a teenager come in with weird neuro sx, and the first thing they thought was drugs. It turned out to be some rare brain, sometimes it is a zebra, lol
  12. by   CapNurse09
    Lung cancer with metastases to the brain
  13. by   northshore08
    Quote from CapNurse2B
    Lung cancer with metastases to the brain
    Now that one gets my vote.
  14. by   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