Eydawn Posted November 26, 2006 Share Posted November 26, 2006 Family hx of cardiovascular or neurological problems? How about family hx of cancer? Known allergens? What position does he play on the soccer field (I know it's a goofy question but as a former soccer player I know it can make a difference in terms of running, maneuvers, etc) Any noted behavior changes other than the memory loss, either by teachers, friends or parents? Any recent illnesses or injuries, car accidents etc? Say within the last year or so, for time reference... How well oriented does he seem other than the memory loss? Does he respond appropriately? Does he respond within a normal time frame, and are his sentences completely coherent? He seems embarrassed... so he is aware of what is happening, and that he should remember but can't? Does he feel any abnormal sensations in his hands, feet, etc. that he's not used to feeling or hasn't experienced before? Ok.. I'll let someone else play.. Wendy CO EMT-B MI EMT-B Link to comment Share on other sites More sharing options...
JPINFV Posted November 26, 2006 Share Posted November 26, 2006 I'll second the question about family history of cancer. What is the condition and age of his house and school (lead paint)? When was the last time the heating system in his house was cleaned? What's the family's economic level (lower, middle, upper class)? Long shot: The kid's a freak, is lieing about EtOH use (no drugs) and has the beginings of Korsakoff's syndrome... /Damn you Dr. Sacks, damn you... Link to comment Share on other sites More sharing options...
nvonschrott Posted November 26, 2006 Share Posted November 26, 2006 Ok, so the parents deny that the patient has a history of seizures. What probably comes to mind to an average person when they think of a seizure? I would guess that most people think of a seizure as consisting of what we usually see in a grand mal seizure. Based on the history given so far, I'm going to put petit mal (absence) seizures at the top of my differential. Link to comment Share on other sites More sharing options...
Lithium Posted November 26, 2006 Share Posted November 26, 2006 I'm going out on a limb here ... but dehydration with ensuing electrolyte disturbances. If I remember correctly, it's either hypokalemia or hypophosphatemia, either way, both would be able to account for the neuro deficits. That, and I would be thinking along the lines as the others in terms of your major neuro problems, but JPINFV has a good thought about the polioencephalitis. :?: Link to comment Share on other sites More sharing options...
hammerpcp Posted November 26, 2006 Share Posted November 26, 2006 Are classmates or fiends/siblings experiencing similar symptoms? Is he on a special or restrictive diet of some sort? Link to comment Share on other sites More sharing options...
brock8024 Posted November 26, 2006 Share Posted November 26, 2006 Wow, are you an internal medicine resident??? He is the youngest of 3 kids, no suicidal ideations, immunizations UTD, does not take any supplements, no contacts or glasses, no night sweats or weight changes, no change in bowel habits. To save space, the rest of the answers are negative. We will cover skin tugor when we get to the PE. This is from my first semister in my paramedic program. We had to do full H&P's on eachother in class and then we had to read them out loud in class. Then everyone got to say what we thought of them. The more we had to read them out loud the more indepth we got. So by the end of the semister we was able to do a full H&P on a pt and not be embrassed to ask certain questions. We ever learned how to do a indepth physical assesment from head to toe. By the way you never said his race. Black, white? Link to comment Share on other sites More sharing options...
brock8024 Posted November 26, 2006 Share Posted November 26, 2006 Did he go to a fair or something on Long Island? I am not familar with The island but I know here in Oklahoma our state fair is in Sept. So I am wondering if maybe he ate something there or possibly came in contact with something. Is he sexually active at all? I mean 15 year old boy maybe has not told his parents he has been sexually active and maybe has a STD. I know some STD's can cause neuro problems. Just thought of something. Any cans of paint around the house. He is 15 and denies drug use maybe he does not think of huffing as a drug. This is a tuff one, because there is nothing out of the ordinary for his daily habits. No trauma that anyone can tell. He is not running a fever or that we know of. He is drinking and eatting normal. Just all of a sudden can not remember short term things. He is just out on the soccer field and runs off to the side and then can not remember things. I am going to go with something internal is causing this. Possible Dx's- SZ, STD, some thing he ingested, or drug gone bad. Link to comment Share on other sites More sharing options...
ERDoc Posted November 26, 2006 Author Share Posted November 26, 2006 No family history of cancer or neuro problems, no allergens. I don't know what position he plays on the team. As far as the parents know there have been no other changes in behavior or memory. He has had a cold or two over the past year, but has otherwise been healthy. He is A&OX3, answers appropriately without delay. His speech is not rushed. He his fully coherent. Yes, he is embarrassed because he knows that he should remember things, but cannot. No funny sensations. He is a white kid from an upper middle class family. Their house is clean and relatively new (no lead paint). There are no other contacts (at home or school) with similar symptoms. Someone mentioned an absence seizure. This is a good thought, but he is a little old for one (but hey, not everyone reads the textbook). No special diet, and not sexually active. He did not go to the state fair this year (which is in Syracuse for anyone that may be interested). To summarize, 15y/o male with sudden onset of memory loss (short term) apparently while playing soccer. No h/o head trauma and very little else for history. Does not seem to be drug or environmentally related. Moving onto the PE: VS 76 110/60 16 100%RA PERRLA, EOMI, CN2-12 intact, 2+ reflexes in all extremities, 5/5 strength in all extremities, cannot remember 5 objects after 5 minutes. No asterixis, Rohmbergs sign. Normal rapid repetitive movement, able to do finger to nose, heel to shin. Gait normal fowards and backwards. Able to count backwards by 7s. Anything else you would like to know about the PE? Link to comment Share on other sites More sharing options...
p3medic Posted November 26, 2006 Share Posted November 26, 2006 whats his blood sugar? the tick bite and geographical local makes me want to rule out lyme disease, although a neoplasm would be worse..... Link to comment Share on other sites More sharing options...
itku2er Posted November 26, 2006 Share Posted November 26, 2006 He cant remember the objects 5 min after you asked him did i read that right? Has he been exposed to any chemicals in chemistry class or anything like that that is known? Any recent weight loss? What are his eating habits does he get enough vitimans? Is he taking steroid of any kind? Link to comment Share on other sites More sharing options...
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