Question

A 70-year-old semiretired janitor with a history of hypertension had a sudden onset of nausea, vomiting, and unsteadiness. She was taken to the ER, where her exam was notable for slurred speech with slowed tongue movements, dysmetria on finger-to-nose testing on the left, dysmetria on heel-to-shin testing on the left and left dysdiadochokinesia (inability to perform rapid alternating movements). Upon attempting to stand, she fell to the left, even when she kept his eyes open. The remainder of the exam was unremarkable.a. On the basis of the signs and symptoms, where is the lesion? b. What is the most likely cause?

Answer 1

The lesion is likely in the cerebellum, indicated by symptoms of cerebellar dysfunction. The most probable cause is medication side effects, such as those related to haloperidol, affecting motor control brain regions like the cerebellum and basal ganglia.

Step-by-step explanation:

On the basis of the signs and symptoms presented by the 70-year-old semiretired janitor, the lesion is most likely located in the cerebellum. This is inferred from the symptoms such as slurred speech with slowed tongue movements, dysmetria on finger-to-nose testing on the left, dysmetria on heel-to-shin testing on the left, left dysdiadochokinesia, and her tendency to fall to the left even with her eyes open. These are classic signs of cerebellar dysfunction. The most likely cause, given that it was a sudden onset with the history of medication, could be a side effect of medication. When considering the side effects of haloperidol, which is a medication used for treating various psychiatric disorders and can potentially be used to help in sleep-related issues, we must focus on brain regions that control motor functions such as the brain stem and basal ganglia in addition to the cerebellum.

Answer 2

(a) The lesion is on the left side of the cerebellum (ipsilateral)

(b) The most likely cause is the occlusion of the cerebellar arteries by a thrombus

Step-by-step explanation:

The cerebellum is primarily involved in the maintenance of posture and balance, muscle tone and voluntary muscle activity.

Dysmetria, dysdiadochokinesia, intention tremor and dysarthria (slurred speech due to ataxia of the laryngeal muscles) are classic cerebellar signs.

Cerebellar lesions may give rise to a hemispheric syndrome, vermis syndrome, etc. which are usually ipsilateral (side affected is same as lesion).

Since the janitor is 70 years old and hypertensive, these are factors that could have predisposed him to thrombus formation (clotting) within his blood vessels. The thrombus formed could have embolized to occlude the cerebellar arteries, leading to inadequate blood supply and in turn, cerebellar dysfunction.