Case Study

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

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

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.

combo of meds and hormone changes, is a possibility

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

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.

Mass in the brainstem?

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

ganglionic blockade in the cerebellum?

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

Lung cancer with metastases to the brain

Lung cancer with metastases to the brain

Now that one gets my vote.

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