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School of Medicine >
Department of Neurology >
Medical Student Cases and Questions >
The Alcoholic Whose Dog Had Died
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A 58 year old white golf caddy was brought to the ER because
of a "blackout". The day of admission, he had a shot of whiskey and three beers
with his breakfast and lunch, repectively. Later that evening, while sitting and
watching the Budweiser frogs on television, his cousin noticed that he started
shaking in his chair. The cousin described staring, rhythmic jerking, the
patient's eyes rolled up, and then foam began to come out of his mouth.
He turned blue and stopped shaking. His cousin could not arouse him and
noticed that his lap was wet. He was lethargic and slightly confused in
the ER. The history was obtained from the patinet's cousin. The cousin related
that the patient had a drinking problem which was exagerated by the end
of the golf season. The patient had been drinking one to two cases of beer
and one half to one full "fifth" of Sky Vodka each day for the last 25 years
since his black Labrador Retriever named Rex had died. He had joined Alcoholics
Anonymous 3 weeks before his admission and had begun to cut down his alcohol
intake. In the ER, he gradually recovered full consciousness and became
less confused. His neurological examination was abnormal because of absent
ankle reflexes and diminished appreciation of all sensory modalities in
a stocking glove distribution. His blood pressure was 190/80 and his pulse
was 110. He was sweating despite a relatively cold ER Room. A CT scan of
the head was normal.
Questions:
- What is the most likely diagnosis?
- What is the differential diagnoses (What are other causes of seizures in an alcoholic)?
- The patient is admitted to your service. What admitting orders would you write?
- What neruotrnsmitter receptor is thought to be involved in alcoholic withdrawal seizures?
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