PakMediNet Discussion Forum : Medicine : internal medicine
internal medicineA young female with vertigo ,headach,diplopia.there is hyperreflexia on left side and six nerve palsy on right side
Posted by: sarfrazPosts: 3 :: 23-09-2006 :: | Reply to this Message
Re: internal medicineThis is most likely a brain steam problem. What is the motor / sensory examination of upper and lower limbs? MRI should be done to find out the cause behind this.
Posted by: yasirPosts: 90 :: 23-09-2006 :: | Reply to this Message
Re: internal medicine
Crossed signs such as 6th nerve palsy on the right and hyperreflexia on the left is suggestive of a possible pontine pathology on the right. Vertigo most likely is related to the vestibular nuclei at the ponto medullary level. 6th nerve palsy can explain the diplopia. See the following article for neuroanatomy at this level
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&list_uids=16633387&cmd=Retrieve&indexed=google
The differential diagnosis will depend on whether this was an abrupt onset or a more insidious progression. Things to consider would be a space occupying lesion in the posterior cranial fossa such as brain tumor, abscess, granulomatous disease, or a vascular problem such as a stroke.
An MRI of the brain would be the ideal test for further evaluation and should be done urgently. If not available atleast a CT scan of the head (ideally with contrast if renal functions are OK) with poterior fossa cuts should be obtained. Do NOT do a spinal tap (LP) at this point. Please update us on the investigations.
Nizam
[Edited by Nizam on 25-09-2006 at 02:59 PM GMT]
[Edited by Nizam on 25-09-2006 at 10:13 PM GMT]
Posted by: NizamPosts: 82 :: 25-09-2006 :: | Reply to this Message