Neurology Main神经内科 1-211-课件.pptVIP

Neurology Main 201-211 Q 201A 23-year-old man is found at the scene of a motor vehicle accident with lower extremity fractures: abdominal bruising, and scalp lacerations. He complains of pain and some shortness of breath. Initially, his blood pressure is 95/60 mm Hg and pulse is 120/min and regular. His spine is immobilized, and peripheral intravenous access is obtained. He is given 1 L of intravenous fluids. On the way to the hospital, he becomes progressively drowsy and develops progressive weakness on the right side of his body. His blood pressure is 160/90 mm Hg and pulse is 50/min. Which of the following nerve functions is most likely to be compromised on physical examination?A. Abducens B. Accessory C. Facial D. GlossopharyngealE. Oculomotor A 201Correct answer:FSudden loss of consciousness (LOC): loss of postural tone, and delayed return to baseline mental status should raise suspicion for seizure (eg, generalized tonic-clonic). Some patients may experience an aura (egr olfactory hallucination) prior to the event and/or lateral tongue lacerations during the event Compared to other etiologies of sudden LOCt generalized seizures almost always have a delayed return to baseline neurologic functioning due to a postictal state of transient confusion, lethargy, and/or focal neurologic deficits.In contrast, syncope is a transient LOG with loss of postural tone followed by immediate spontaneous return to baseline neurologic function. The most common cause of syncope is vasovagal syncope, which may be preceded by a prodrome of nausea, warmth: lightheadedness, and/or diaphoresis. Pallor and weak pulses (due to vagal nerve activation) strongly suggest syncope.(Choice A) The patients recent psychosocial stressors raise concern for ingestion, but acetaminophen toxicity causes a predictable sequence of nausea/vomiting, right upper quadrant pain with elevation of liver enzymes, and potential liver failure and death. Seizures are not typical.(Choices B and C) Orthostatic hypo