However, it was felt unlikely given the lack of other classic symptoms. The neurologist raised the possibility of COVID-19 in a phone call with the hospitalist. However, the mild fever which had started an hour before the neurological examination was unexplained. He was diagnosed with TGA with no further neurological investigations or therapies. Electroencephalogram (EEG) was also normal. The neurological examination including a detailed mental state examination was completely normal. He remembered sleeping well the night before with the help of his CPAP, waking up feeling fine in the morning, and remembered the events of the prior day including starting his work shift but nothing after that until being inside the MRI machine and feeling claustrophobic. When evaluated by general neurology (about 17 hours from symptom onset), the patient was feeling back to normal. The patient was admitted for observation and a brain MRI which was done overnight. The ED team first called the oncall stroke neurologist and the impression was possible transient global amnesia (TGA) not stroke. The only abnormal laboratory findings were serum sodium 134 mEq/L, serum calcium 7.9 mg/dL, and serum glucose 179 mg/dL. Laboratory tests included complete blood count, basic metabolic profile, liver function tests, serum troponin, urinalysis, and urine drug screen. Electrocardiogram and head CT were obtained and were normal. Otherwise, his language function was normal and he did not have focal any neurological deficit. He was inquiring repeatedly about what was happening and how he got to the ED. On neurological examination, he was alert and oriented to place and persons but not time or date. Generally, he looked well with no pallor or cyanosis, no evidence of trauma, had moist oral mucosa, normal posterior pharynx, supple neck, clear lung auscultation without wheezes, rales or rhonchi, normal cardiac auscultation, strong symmetric radial pulse, soft non-tender non-distended abdomen, had no peripheral edema, and no rash. ![]() His oxygen saturation was 98% on room air. His initial vital signs showed mildly elevated blood pressure (150/87 mm Hg) but no fever (36.7☌), tachycardia, or tachypnea. He was an occasional alcohol drinker but was not a smoker and did not use illicit drugs. He was mildly obese (body mass index 32.7 kg/m 2) and had obstructive sleep apnea (OSA) that was well managed with continuous positive airway pressure (CPAP) device but was otherwise quite healthy and active individual with no history of prior seizures, migraine, or other neurological conditions. The patient had known asthma and used various beta agonists and steroid inhalers at home. He was feeling lightheaded but denied fever, chills, congestion, shortness of breath, chest pain, palpitation, diaphoresis, nausea, or vomiting, recent illness or trauma, recent exposure to COVID-19 cases or other sick persons. In the ED, he was awake and alert, knew who he was and where he was but did not remember what had happened at work and how he was brought to the hospital. They called his wife who brought him to the emergency department (ED) about 3 hours from symptom onset. All subjects Allied Health Cardiology & Cardiovascular Medicine Dentistry Emergency Medicine & Critical Care Endocrinology & Metabolism Environmental Science General Medicine Geriatrics Infectious Diseases Medico-legal Neurology Nursing Nutrition Obstetrics & Gynecology Oncology Orthopaedics & Sports Medicine Otolaryngology Palliative Medicine & Chronic Care Pediatrics Pharmacology & Toxicology Psychiatry & Psychology Public Health Pulmonary & Respiratory Medicine Radiology Research Methods & Evaluation Rheumatology Surgery Tropical Medicine Veterinary Medicine Cell Biology Clinical Biochemistry Environmental Science Life Sciences Neuroscience Pharmacology & Toxicology Biomedical Engineering Engineering & Computing Environmental Engineering Materials Science Anthropology & Archaeology Communication & Media Studies Criminology & Criminal Justice Cultural Studies Economics & Development Education Environmental Studies Ethnic Studies Family Studies Gender Studies Geography Gerontology & Aging Group Studies History Information Science Interpersonal Violence Language & Linguistics Law Management & Organization Studies Marketing & Hospitality Music Peace Studies & Conflict Resolution Philosophy Politics & International Relations Psychoanalysis Psychology & Counseling Public Administration Regional Studies Religion Research Methods & Evaluation Science & Society Studies Social Work & Social Policy Sociology Special Education Urban Studies & Planning BROWSE JOURNALSĪ 53-year-old male pharacist was in his normal state of health when, 2 hours into the afternoon shift at the retail pharmacy he works at, his coworkers noticed that he was confused asking repetitive questions.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |