I know: the course is over, the exam has been taken (and the results are not bad at all!) - but the following story is of some interest in your class, and i would expect at least one idea of what could have caused the symptoms in the lady...:
Yesterday I got an email from a lady from Brooklyn. She is about 30-35 years old, has an 11 yo son, works, seems to lead a healthy lifestyle...had no significant illnesses.
Here is what she wrote:
" ...I had some twitching on my tongue and neck accompanied with shortness of breath. They did an EKG and my primary care physcian has referred me to see a cardiologist because "there is an abnormality in my EKG..."
She is very worried and scared.
So, what do you think? What would you do with this patient? What would you ask her, what are these symptoms about, what could her condition be...?
Send me your comment....
Meanwhile I will ask around, and I suppose I will also hear from her and see what came out of her referrals and maybe get a meaningful answer. I don't have her EKG and do not know what the "abnormality" was. What abnormality would you expect, in line with the above symptoms??
Well, I was hoping you would try this one...You can of course look up under "tongue fasciculation" and would quickly see that there are some serious conditions (nerve muscle diseases)that could be the cause of this - but that the majority of such incidences are benign and referred to as benign fasciculation syndrome. But it is also stated that these symptoms are like those seen in organophoasphate poisoning, something I mentioned to you when we talked about nerve poisons in the course - specifically mentioning tongue fasciculations as a symptom in class: and that I hoped you would maybe remember. So, then the whole problem might boil down to having been exposed to some cholinomimetic, with the bronchuial constriction fitting right in there. But the lady did not report salivation - which should have been there. I hope to get some reply from our patient in due time and will report here in a comment what her condition isd all about...
ReplyDeleteFeb 2012 update: Unfortunately the lady never told me what the result of her workup was. She was to see a neurologist but delayed (or cancelled) hr appointment, maybe ebcause symptoms did not recur.
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