Neurology Clerkships
Case 38  
Author: Eric Kraus, MD
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For this case please determine the cause of coma and the prognosis for waking up.

This is a 72 year-old woman who had witnessed syncope in a department store today. Prior to this she was feeling well. When the medics arrived she was in v-tach. CPR was performed including three rounds of defibrillation. Resuscitation time from syncope to a perfusing rhythm was 35 minutes.

On day 2 she was not waking up so a neurology consult was called. Inpatient medications include Amiodarone, ASA, Metoprolol, and sq. heparin. No sedatives.

1. Chronic low back pain
2. HTN
3. Hyperlipidemia
4. ASCVD. Stable angina.

1. Vioxx
2. ASA 81mg qd
3. Pravastatin 20mg qd
4. Diltiazem CD 120mg bid
5. Isordil
6. Lisinopril 10mg qd
7. MVI
8. NTG prn

Allergies: NKDA

Family History: Noncontributory

Social History: Lives with husband. One healthy daughter..

BP 142/80   HR 78   T 37.8°C
General: Intubated.
Mental Status: Coma.
HEENT: PERRLA. Positive Doll's eyes. Cold calorics positive bilaterally for tonic deviation of both eyes. Corneal reflexes positive.
Motor (Power/Tone/Bulk): Decorticate posturing to central pain.
Sensory: Can't test.
Reflexes: 2/4 throughout. Upgoing toes to plantar stimulation.
Coordination: Can't test.
Gait: Can't test.
Abnormal Movements: None
Other Organs: RRR without murmur. Lungs clear to auscultation.
Initial EKG: Abnormal. Sinus rhythm at 72. ST elevation in V4-V6 indicative of acute infarction.

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