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Tracy
01-08-2006, 08:36 PM
I could use your thoughts and ideas for the following case:

Previous history: Longstanding bipolar disorder - treated with counseling and medications. Recent significant increase in stress. Strong family history of heart disease, but with regular stress tests negative.

Recently had several incidents when this 59 y.o. male was driving his car, and got to the destination but couldn't remember getting there, and a second recent incident when he was riding his motor scooter and couldn't remember getting there. Also with a recent fall or two - not sure the circumstances.

This event occurred on Sunday: He was fishing with his grandson in approx. hip deep water...grandson turned around just in time to see him go under the water - grandson able to get him by the arm and get him to shore. He was by that time conscious (no one seems to be quite sure if he lost consciousness before/when he went under the water). He told his grandson that his legs were numb and had him wrap him in his solar blanket - then grandson went for help.

At hospital - speech was affected...speech was clear, but he talked very slowly with a pause between each word. He couldn't remember his birthdate or the president. MRI and EKG were run and were negative. Carotid testing and a brain scan were done, with results pending as of last night. Yesterday, speech was normal, but he couldn't remember the incident the day before. Can remember things that happened before the incident, remembers family, etc. However, if asked a pointed question, for example "how much do you weigh?, How old are you?, What was your previous occupation?" he cannot answer these questions. He says he can "see" the answer, but cannot articulate it, which of course, has created a lot of frustration on his part.

I would like your ideas on what this could be. Initially, I was thinking stroke, given the language that was affected...but that doesn't fit with bilateral leg numbness and the previous incidents of loss of memory when he was driving. So then my mind goes to something like MS (but wouldn't some brain lesions show up on MRI?) or maybe some toxic build up of something in the body.

So far, as the tests have been negative, and the doctors don't know what's going on, they are saying it's due to the stress and the bipolar disorder, but I don't buy it.

Thanks in advance for your thoughts.

Tracy

emad
01-08-2006, 10:00 PM
Tracy:
Just off-track my post because my reasoning regarding your patient is not competent enough to give a view .

I think the neurological reasoning skills from physiotherapists can NOT be compared to their reasoning skills /competencies in neuromusculskeletal speciality .I feel regret /sorry for physiotherapist to neglect their skills in Neuro-rehabilitation (because there no other rehabilitation therapist or chiros work in that spciality) we can do very good at this neuro-rehabilitation part.

There is great difficiency /lack on the web /internet concerning physiotherapy neurorehabilitation ,may be the neurology-theory itself has not progressed so much within human productivity ,however for me it is so strange a humanity of not less than 300 millions years age on this earth planet with no clear progress in neurology or in whole medicine theory .

Bit off-track .

Cheers
Emad

Jason Silvernail
01-08-2006, 11:10 PM
I think the opinion you really need here is that of the Neurologist.

I don't know that any PT is qualified to really make that call. But it is an interesting set of symptoms - good to talk through for learning purposes...

J

Tracy
02-08-2006, 12:03 AM
Hey all - don't get me wrong - I'm not trying to overstep any neurologists, etc. in the diagnosis of this patient. I know P.T.s aren't supposed to diagnose, etc. But I am frustrated that so far the docs are attributing this to the bipolar disorder, and was just looking for some input from others....as Jason said, "talking through it for learning purposes".

Thanks -
Tracy

nari
02-08-2006, 12:31 AM
Symptoms of MS usually appear long before anything shows on imaging; but these symptoms are not typical of MS. I suspect a SOL (possibly meningioma) and certainly something is odd with ST memory; plus the language difficulties.
Maybe the bipolar is a symptom; but bipolar itself does not cause such neurological changes.
The CT may or may not reveal a lot; but the question is asked: why is he seeing you? With obvious red flags from the history?

Nari

Carlos
02-08-2006, 01:50 AM
One must also address whether this is a stable condition or has the patient deteriated over days/weeks/months.

Carlos

Tracy
02-08-2006, 09:21 PM
Nari -

This is not my patient...this is the father of a dear friend of mine. My friend called to talk to me and ask my opinion on his case, so am just looking for some input to help guide her and her family in making additional medical decisons. Sorry if I was misleading...it wasn't intentional!

I agree that the bipolar disorder does not explain his symptoms, but wanted to get other opinions in that regard. I would hate to see the docs miss something because of the bipolar history. You also have to understand that this incident happened in "small town" Montana, and although I'm sure his doctors are good, it's not like they are the top experts in this field.

Meningioma - wouldn't that show on scans or MRI??

Carlos -
What I currently know about the nature of his condition: bipolar disorder is long standing and has been more or less stable for a number of years...the recent incidents of memory loss during driving and the fall have been in the last 1-2 months