Case Study

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Specializes in Psychiatry, Case Management, also OR/OB.

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???

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Specializes in Emergency, critical care.

Tegratol toxicity has similar sx.....check her meds. for adverse reactions...

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I'd would wonder about medication toxicity or adverse reaction as well.

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Specializes in ED.

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.

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combo of meds and hormone changes, is a possibility

why are staff nurses of the opinion that she is faking?

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Specializes in Psychiatry, Case Management, also OR/OB.

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.

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Specializes in ED.

Mass in the brainstem?

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Specializes in Emergency, outpatient.

I've never seen a patient fake nystagmus. Is it something to do with heavy nicotine?

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Specializes in ER/ICU/Flight.

ganglionic blockade in the cerebellum?

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http://wiki.cns.org/wiki/index.php/Basilar_artery_penetrating_artery_occlusions

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 anomaly.......so, sometimes it is a zebra, lol

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Lung cancer with metastases to the brain

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Specializes in Emergency, outpatient.
Lung cancer with metastases to the brain

Now that one gets my vote.

:yeah:

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