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This 35 y/o white male presented with a chief complaint of vertigo and
ataxia. Several days before admission, he had exercised vigorously at his
sports club and noticed the acute onset of a left posterior cervical ache
which persisted. The night before admission fell asleep in an awkward position
on the sofa. He awoke in the middle of the night and got up to go to the
bathroom. As he was returning from the bathroom, he yawned and stretched
'vigorously'. Immediately afterwards he had the acute onset of vertigo,
nausea, vomiting, and left-sided weakness. He actually said that the weakness
"felt rubbery. His gait was clumsy. He experienced tingling in his fingers
and toes. He had a left occipital headache. He decided to go back to sleep,
but when he awoke the next day, he felt no better and came to the Stony
Brook ER.
In the emergency room, the only abnormal findings were in the neurological
examination. There was gaze-evoked nystagmus, left finger-to-nose dysmetria,
left heel-to-shin dysmetria, and an ataxic gait with a tendency to fall
to the left. An imaging study showed an infarct of the brain.
Questions:
- What is the presumed anatomical location of the lesion causing the
patient's symptoms?
- What is the differential diagnosis of a stroke in a young adult?
- What test(s) would you order to evaluate this lesion?
- How would you treat this patient?
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