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Леонора
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Вот мне задачка пришла в рассылке (я в неврологии ничего не понимаю). Может кому-нибудь будет интересно:
BACKGROUND
An 82-year-old man presents to the clinic with progressive difficulty swallowing and dysphagia over the last several weeks. He has been unable to eat food or drink water for the last 6 days and is thirsty. He denies odynophagia but reports that his speech has become slurred concurrently with his other difficulties. He denies having motor or sensory deficits, headache, fevers, urinary symptoms, malaise, or fatigue.
On physical examination, the patient's vital signs are normal with a heart rate of 78 beats per minute and a blood pressure of 132/67 mm Hg. Pulse oximetry is 98% on room air. He has slurred speech. Examination of the head and neck reveals a normal oropharynx with intact tongue movements and a preserved gag reflex. However, the patient has bilateral, symmetric palpebral ptosis with a masklike face. In addition, he has to tilt his head back to look straight ahead. Because of an inability to lift his eyelids, he seems to be furrowing his eyebrows to compensate.
The patient has normal motor strength, including strength in the extensors of his wrist and deltoids. He has intact sensation in his extremities and symmetric and normal deep tendon reflexes, and he can walk with no pronator drift. The patient has no difficulty breathing.
What is the diagnosis?
BACKGROUND
An 82-year-old man presents to the clinic with progressive difficulty swallowing and dysphagia over the last several weeks. He has been unable to eat food or drink water for the last 6 days and is thirsty. He denies odynophagia but reports that his speech has become slurred concurrently with his other difficulties. He denies having motor or sensory deficits, headache, fevers, urinary symptoms, malaise, or fatigue.
On physical examination, the patient's vital signs are normal with a heart rate of 78 beats per minute and a blood pressure of 132/67 mm Hg. Pulse oximetry is 98% on room air. He has slurred speech. Examination of the head and neck reveals a normal oropharynx with intact tongue movements and a preserved gag reflex. However, the patient has bilateral, symmetric palpebral ptosis with a masklike face. In addition, he has to tilt his head back to look straight ahead. Because of an inability to lift his eyelids, he seems to be furrowing his eyebrows to compensate.
The patient has normal motor strength, including strength in the extensors of his wrist and deltoids. He has intact sensation in his extremities and symmetric and normal deep tendon reflexes, and he can walk with no pronator drift. The patient has no difficulty breathing.
What is the diagnosis?
Sol. Piracetami 10,0 в дело пойдет! А за что ему ГБ3?
